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Full text of "Consumption : what it is and what to do about it"

Consumption 




JOHN B. HAWES, 2d, M. D. 

Boston 
SMALL, MAYNARD & COMPANY 




EDNA L FOLEY 



^Presented to the 
Hartford Hospital School of Nursing 

in memory of 

Martha J. Wilkinson, Class of 1890 
Hartford's first visiting nurse 

by her friend 

Edna L. Foley, Class of 1904 



CONSUMPTION 




LLU4J ill 



WELFARE SERIES 



CONSUMPTION 

WHAT IT IS AND WHAT 
TO DO ABOUT IT 



BY 

JOHN B. HAWES, 2nd, M.D. 

Instructor in Medicine Harvard Medical School, Director 
Tuberculosis Clinic, Assistant Visiting Physician 
Massachusetts General Hospital, Secretary Massa- 
chusetts Tuberculosis Commission 




BOSTON 

SMALL, MAYNARD AND COMPANY 
PUBLISHERS 



Copyright, 1915 

By Small, Maynard & Company 

(Incorporated) 



PREFACE 

I fully realize that there are already many books, 
large and small, that are intended to give the gen- 
eral public some definite knowledge on the subject 
of tuberculosis. My only criticism of many of 
these books is that they are either so short that cer- 
tain important practical details are omitted and thus 
present only a summary of the subject, or else they 
are so long and so replete with historical informa- 
tion and scientific discussion, that they defeat their 
own purpose. I have tried to make the present vol- 
ume a mean between these two extremes. 

This book is in no way intended to take the place 
of a physician, but to be of service to him, to the 
patient, and the patient's family. The busy practi- 
tioner cannot be expected to have more than a gen- 
eral idea as to the cost of living at Saranac Lake, 
for instance, and how to get there. Such informa- 
tion and other of like nature I have included in this 
book. My hope is that it will prove of value. 

John B. Hawes, 2nd. 



CONTENTS 

CHAPTER PAGE 

Preface iii 

I What Consumption is and What it Does . . g 

II How Germs of Tuberculosis Get Into the Body 12 

III Bovine Tuberculosis 15 

IV Early and Important Symptoms of Pulmonary 

Tuberculosis 17 

V What to do if you Think you may have Con- 
sumption 20 

VI What to do if you are Told and Know that 

you have Consumption 22 

VII Home Treatment 25 

VIII How to Llve and Sleep in the Open Air. By 

Thomas Spees Carrington, M.D 28 

IX Treatment in a Local or not far Distant San- 
atorium. HOW TO GET THERE AND WHAT IT 

COSTS 45 

X Saranac Lake. Where it is, what it Offers 

to the Consumptive, and how to get there 50 

XI Colorado and the West 55 

XII After the Sanatorium, then What? ... 57 

XIII Tuberculosis in Childhood 60 

XIV How Parents can Help in the Prevention and 

Cure of Tuberculosis in Children .... 62 
XV Fresh Air Rooms and Open Air Schools. 

What They are and What They are for 65 
XVI Consumption and Marriage. What should 
Consumptive Parents do about Their Chil- 
dren? 68 



CONTENTS 

CHAPTER PAGE 

XVII The Problems of Paying the Bills in Con- 
sumption, and How They have been Solved 71 

XVIII Drugs and Cures for Consumption; Their 

Use and Abuse 76 

XIX Diet in Consumption 78 

XX How to Keep from Giving Consumption to 

Others 82 

XXI General Remarks 85 

XXII Hints and Helps for Tuberculosis Patients. 

By Charles E. Minor, M.D 90 



CONSUMPTION 



CONSUMPTION 

CHAPTER I 

WHAT CONSUMPTION IS AND WHAT IT DOES 

Tuberculosis is a disease caused by a germ or 
tiny plant called the tubercle bacillus. This germ 
enters the body usually by way of the mouth and 
goes to the lungs, or elsewhere and then grows and 
causes the disease tuberculosis. When the disease 
is in the lungs it is known as pulmonary tubercu- 
losis, consumption, or phthisis. The germ may go 
to any part of the body and there cause disease. 
Pott's Disease or tuberculosis of the spine or hump- 
back; hip disease, white swelling of the knee or 
ankle; lupus, tuberculosis of the skin, scrofula, tu- 
berculosis of glands, and tuberculosis of the spe- 
cial organs, such as the eye, ear, nose, throat, 
kidneys, etc., are all manifestations of this disease. 
No matter where located, tuberculosis is always the 
same and due to the same cause. 

The disease is a very ancient one. Traces of it 
have been found in Egyptian mummies ; it was well 
known to Greek, Arabian and Roman doctors, 
philosophers and historians. Up to comparatively 
recent times, it was considered an absolutely in- 
curable disease, and not until the early part of the 

9 



io CONSUMPTION 

last century did it begin to be realized that con- 
sumption could be cured. The modern sanatorium 
movement, by which tuberculosis is treated by sun- 
shine, fresh air, good food and rest, began in the 
Black Forest in Germany and from there has spread 
all over the world. 

The exact cause of the disease was not discov- 
ered until 1884, when Robert Koch of Berlin iden- 
tified and isolated the tubercle bacillus. This was 
a great step in advance, in that it enabled us to 
carry on the fight intelligently. Since that time 
the campaign against consumption has aimed to 
accomplish two things; first, to destroy the germ 
which causes the disease and to prevent its entrance 
into the body in every way possible; and, second, 
to teach people how to live so that they will be 
strong, healthy, and, by their own vital forces, 
able to ward off tuberculosis and other diseases. 
On these two great principles rests the entire anti- 
tuberculosis campaign. 

It is unnecessary to mention, except in the most 
general way, the importance of this campaign 
against consumption. In the United States alone 
over 200,000 people die of it every year, while in 
the world over 1,000,000 inhabitants annually suc- 
cumb to this disease. Compared with tuberculosis, 
the acute infectious diseases of childhood sink into 
insignificance, and even those much dreaded dis- 
eases, small-pox, yellow fever, leprosy, and even 
cancer, do infinitely less harm and kill a vastly 
smaller number of people. 



WHAT CONSUMPTION IS n 

In order to combat such a plague as this, and 
such an insidious enemy, it is essential for every 
one to have some plain and definite information 
about the disease, how to keep from getting it, how 
to cure it, and how to keep from giving it to others. 



CHAPTER II 

HOW GERMS OF TUBERCULOSIS GET INTO THE BODY 

Tuberculosis, or consumption, is primarily a 
home or house disease. This means that it is trans- 
mitted from one person to another in the early years 
of life in the intimate contact of the home. In 
the majority of instances, when a person gets con- 
sumption, it means that some one has been either ig- 
norant or careless, or both. The disease is spread 
by means of the sputum. As the process develops 
in the lungs, the germs grow and multiply, and the 
lung tissue is destroyed. This broken down lung 
substance, often containing millions of tubercle 
bacilli, is raised by coughing and discharged as spit 
or sputum. Thus the great majority of cases of 
consumption comes from other cases. The sputum 
which the careless consumptive spits out on the 
floor, sidewalk, or elsewhere, dries, is ground up into 
dust and may be breathed in by some young child 
who thus becomes infected with the disease. In- 
fection may take place by direct inhalation, in which 
case the germs are breathed directly into the lungs, 
or the germs may lodge in the mouth or throat and 
thence be carried by food or saliva into the stomach 
and from there into the lungs or, finally, the germs 

12 



GERMS OF TUBERCULOSIS 13 

may be taken up by the lymph vessels and by this 
means carried eventually to the lungs. The exact 
path of infection is not so important to bear in mind 
as the fact that the germs almost always get into the 
body through the mouth. 

Tuberculous infection is the rule rather than the 
exception, but there is a vast difference between tu- 
berculous infection and tuberculous disease. Tu- 
berculous infection means that somewhere in one's 
body, usually in the lymph glands, there are some 
germs of tuberculosis which, however, may do no 
harm in any w T ay. It has been proved beyond doubt 
that almost every adult has germs of tuberculosis 
somewhere in his body, and that by the time nearly 
every child reaches his fifteenth year, he has been in- 
fected with this organism. The fact that most of 
us are well and strong and that we are quite una- 
ware of the presence of this most unwelcome visitor 
is the best evidence we have of the curability of this 
disease. 

Tuberculous disease is of course quite a different 
thing. This means that in some way or other, be- 
cause of inherited weakness, bad habits, bad living 
conditions, etc., the system has been weakened and 
the powers of resistance lessened so that the germs 
of tuberculosis grow and multiply and produce 
symptoms. When this happens it is an indication 
that the tuberculous infection, usually already pres- 
ent, has changed into tuberculous disease. 

Whether or not active tuberculosis or consump- 
tion develops in the body depends, therefore, on va- 



14 CONSUMPTION 

rious factors. It is, for instance, comparatively 
rare in persons over sixty years and under fourteen 
or fifteen years. Thus the age is important. The 
disease usually develops between the ages of 15 and 
35 years. Again, much depends on the physical 
condition. A constitution weakened either from in- 
herited tendencies or from overwork or disease falls 
an easy prey to tuberculosis. The length and inti- 
macy of exposure is a third most important factor 
in tuberculous infection. We are most of us able 
to cope with a small number of such germs even for 
a long time, or a fairly large number at once, but 
even the strongest and healthiest of us cannot with- 
stand the continued invasion of our bodies by large 
numbers of germs. Thus, whether or not tubercu- 
lous infection becomes tuberculous disease depends 
in large measure on the length and intimacy of ex- 
posure to the outside source of contagion. 

It is important to remember, therefore, first, that 
it is practically impossible to escape entirely these 
omnipresent germs of tuberculosis, but that, if we 
keep our bodies strong and well, we need not worry 
about contracting this disease, and, second, that any- 
thing which tends to lower our vital forces and bod- 
ily resistance, such as alcohol, overwork, neglected 
coughs and colds, and other diseases such as syphilis 
will greatly increase the chances that the disease may 
gain a foothold and cause consumption to develop. 







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CHAPTER III 

BOVINE TUBERCULOSIS 

There are various forms and varieties of tubercle 
bacilli. The two great groups into which they are 
divided are the human and the bovine types. It 
has been found that the germ which causes tuber- 
culosis in cattle varies in many ways from the germ 
causing human tuberculosis. It is likewise true, 
however, that the bovine type of organism may and 
often does cause tuberculosis in human beings. 
The great source of such infection, naturally 
enough, is the milk of cows having tuberculosis. 
It is possible that a large percentage of cases of 
what is called " surgical " or non-pulmonary tuber- 
culosis, such as bone, joint or glandular disease, 
comes from this source. Butter and cheese, both 
milk products, and beef are likewise possible sources 
of infection. 

For these reasons a clean milk supply is essential. 
There are many who think that there is much exag- 
geration and needless alarm in the modern campaign 
for clean dairies and healthy cows free from tuber- 
culosis and other diseases. This, however, is the only 
way in which we can eliminate the danger of infec- 
tion from this source. Prevention is far better than 

15 



16 CONSUMPTION 

cure and costs less. Pasteurizing all milk whenever 
there is any reason for doubt is a simple procedure 
and a sure way to remove all its dangers. The milk 
to be pasteurized is simply heated to 165 F., kept 
at this temperature for twenty minutes, and is then 
allowed to cool on ice. The nourishing qualities 
and digestibility of the milk are in no way impaired 
by this process. 

Under ideal conditions it ought not to be 
necessary to pasteurize milk. Milk from a tuber- 
culin-tested herd is perfectly safe. Such herds are 
at present hard to find, however, and it w T ill be many 
years before the public realizes the necessity of de- 
manding that this be done to all herds. 

In the meantime, if in any doubt, pasteurize your 
milk. 



CHAPTER IV 

EARLY AND IMPORTANT SYMPTOMS OF 
PULMONARY TUBERCULOSIS 

Consumption is a local disease with both local 
and general manifestations. In other words, al- 
though the tuberculous process is localized in the 
lungs, its symptoms may refer not only to the 
lungs but to every part and organ of the body. 
Hence the terms " local " and " constitutional " 
symptoms. Failure to recognize this fact on the 
part of physicians has led to many errors in diagno- 
sis. 

LOCAL SYMPTOMS 

Cough is an early and constant symptom ; w 7 ith the 
cough there may or may not be sputum. There is 
no cough characteristic of consumption. The so- 
called " hacking " cough is no more characteristic 
of consumption than any other kind of cough. 
Any cough which lasts over three or four weeks re- 
gardless of anything else should be carefully in- 
vestigated. 

Blood spitting is a most important sign. It is 
far safer to take it for granted that the raising of 
blood, blood spitting, either clear or mixed with 
sputum, in large or small amounts, with or without 

17 



18 CONSUMPTION 

cough or other symptoms, means tuberculosis of the 
lungs until the contrary is definitely proved. Fail- 
ure to do this has resulted in countless tragedies. 
If your physician says that the blood comes from 
the nose, teeth, gums, tonsils, throat or stomach, go 
to another doctor and get this statement confirmed. 
It is possible for blood to come from any of these 
sources, but very improbable. 

Pleurisy causing pain in the chest is usually a 
form of tuberculosis. If the pleurisy is a " wet " 
one, i.e., accompanied by water inside the chest, it is 
practically always due to tuberculosis and should be 
treated as such. 

Hoarseness lasting over a few w 7 eeks is an impor- 
tant symptom, requiring rigid investigation. It 
may be an early sign but is usually a late manifesta- 
tion of the disease. 

CONSTITUTIONAL SYMPTOMS 

These symptoms about to be described are of the 
utmost importance; likewise they are most fre- 
quently disregarded. 

Fever, unless the real cause is clear and definite, 
should be looked upon as very suggestive of tuber- 
culosis. When a person becomes hot and flushed 
in the late afternoon, and on taking the temperature 
is found to have some fever, even though slight, 
look out for tuberculosis. Call the doctor and have 
him investigate it. The normal temperature is any- 
where from 97 to 98.9 Fahrenheit. A tempera- 
ture of 99 or over requires investigation. 



PULMONARY TUBERCULOSIS 19 

Loss of weight. The average person either gains 
weight or holds his own weight with slight varia- 
tions, depending on the season and other self-evi- 
dent causes. Any loss of weight, sudden or grad- 
ual, which cannot be explained is a serious condition. 
If this loss of weight is accompanied by a loss of 
strength and energy, the condition is a doubly seri- 
ous one. Constant fatigue, " that tired feeling/' 
especially in the morning, listlessness, ease of tire, 
should have some adequate explanation. If none 
can be found tuberculosis must be at least consid- 
ered as a possible cause. Night sweats, chills, 
flushes, pallor, loss of appetite, all sorts of dyspep- 
sias and irritability are minor symptoms to which 
the physician's attention should be called. " Influ- 
enza/' " malaria," " low fever," " walking typhoid," 
are frequent diagnoses given to explain symptoms 
really caused by tuberculosis. 

The important signs and symptoms of early tu- 
berculosis, or consumption, therefore, with which 
the layman should be familiar are as follows : 

1. A cough with or without sputum lasting over 
four weeks. 

2. Blood spitting. 

3. Unexplained fever, especially if associated 
with a rapid pulse. 

4. Unexplained loss of weight and strength. 
These may not mean tuberculosis, but in the great 
majority of instances they do, and therefore require 
thorough investigation. Do not neglect them, But 
go to a doctor and tell him about them. 



CHAPTER V 

WHAT TO DO IF YOU THINK YOU MAY HAVE 
CONSUMPTION 

In the last chapter the important signs and symp- 
toms of early consumption were discussed. If you 
have any of these symptoms, or if for any reason 
you think you may have the disease, do not delay, 
but go to your doctor at once and tell him about it. 
Remember that this may be the most important step 
in your life; that tuberculosis is easy to cure if taken 
in hand early enough, but that in the later stages it 
is most difficult and often impossible to cure. There- 
fore, if you have a cough with or without sputum, 
especially if it is associated with loss of weight, 
strength, etc., or if you feel tired and listless zvith- 
out good reason, and always if you have ever spat 
up any blood, go to the best doctor you can find 
and tell him frankly all about it. If the doctor says 
you are simply run down, or have a mild bronchitis, 
or that the blood came from your nose or throat, re- 
member that all doctors are liable to make mistakes, 
and that you may possibly have tuberculosis after 
all. If, after faithfully following out the treatment 
he has outlined, you still feel just as badly as be- 
fore, go to another doctor, or a tuberculosis dis- 

20 



WHAT TO DO 21 

pensary or to a specialist on the subject. Remem- 
ber that it is your life and your health which is at 
stake and that you have a right to secure as many 
opinions as you please. 

If you live in a large city or town, there is almost 
sure to be an anti-tuberculosis association which 
maintains or can refer you to a good dispensary 
where specially trained men can examine you. If 
there is no such organization, write for advice as to 
where to go and what to do to your State Board of 
Health, or your State tuberculosis association. In 
Massachusetts, for instance, a letter addressed to 
the State Board of Health, the Massachusetts Tu- 
berculosis Commission, or the Massachusetts Anti- 
Tuberculosis League, Boston, or a letter to the 
National Tuberculosis Association, New York City, 
will reach the proper designation and will bring a 
prompt and reliable answer to all your questions. 

Remember that your health is your stock in trade 
and your bank account. No sacrifice is too great to 
guard it. Even if it costs a great deal in time, 
trouble and money, it is all well spent and invested 
at high interest if you find out the exact condition 
of your health, and whether or not you have con- 
sumption. You are like one fighting in the dark un- 
til you know the exact state of affairs. Knowledge 
is power and will enable you to act intelligently and 
to keep your health, ward off disease, or to cure it. 



CHAPTER VI 

WHAT TO DO IF YOU ARE TOLD AND KNOW THAT 
YOU HAVE CONSUMPTION 

Let us now take up the case of a man or woman 
who has had some of the symptoms above described, 
who has been to a good doctor or dispensary, and 
has been told that he or she has consumption in its 
early stages. What are you going to do about it? 
.What is the next step ? These are constantly recur- 
ring questions, and on the correct answers to them 
hang life and happiness. 

In the first place, do not give up. Make up your 
mind to fight. Remember that countless thousands 
have had the same problem to meet that you now 
have, and have faced it bravely and have won out. 
What they have done, you can do. Remember, also, 
that you are dealing with a chronic, one of the most 
chronic, diseases. It has taken many months or 
even years for the disease to develop in your body, 
and it will take as long a time to conquer it. Pre- 
pare to spend at least the next year of your life in 
getting well. Do not think you can carry on any 
other occupation or business at the same time. 

The best occupation for a consumptive is that of 

22 



it 



WHAT NEXT TO DO 23 

getting well." This wise motto stands over the 
entrance to one of the oldest and most famous san- 
atoria in the world. 

Do not look too far ahead or attempt to do 
everything at once. The patient often under- 
goes a sort of panic or mental collapse after he is 
told by the doctor, no matter how kindly, that 
he has consumption. This may occur in your case. 
It will soon pass off and you will find yourself able 
to face bravely and even cheerfully the problems 
of the present and the future. If your doctor gives 
you no clear or definite instruction, but merely deals 
in vague generalities, such as to " live outdoors," 
or to " go out West," go to another doctor who can 
and will outline for you a practical and clear plan of 
campaign. This is of vital importance. 

Make up your mind to do something, and to do it 
at once. Put away all pride unless your finances 
are such that you can afford this luxury. Few of 
us are able to do so. It takes a long time, and 
costs money, to cure consumption, and your plans 
must include not only the present but the future. 
Do not worry any more than you can help. This 
never did any good. If you are "up against it" 
financially, there are many state, county or munici- 
pal sanatoria where the cost is little or nothing. Be 
an optimist. 

As a general thing, there are three courses open 
to you, which will be considered in detail in subse- 
quent chapters. 



24 CONSUMPTION 

i. Home treatment. 

2. Treatment in a local or not far distant sana- 
torium. 

3. Treatment at a distance and in another cli- 
mate, such as Colorado and the West or South. 



CHAPTER VII 

HOME TREATMENT 

What the home treatment of consumption should 
be and what it usually is are unfortunately two 
very different things. Of late years we have made 
tremendous advances in this method. Ten years 
ago, home treatment merely meant that the patient 
lived at home ; he rarely slept outdoors ; he followed 
no definite rules or regulations as to exercise, rest, 
etc., and was under no close or adequate super- 
vision. To-day, thanks to the work of Dr. Charles 
L. Minor of Asheville, North Carolina, and of Dr. 
Joseph H. Pratt of Boston, the " home sanatorium 
treatment," as it is called, may be one of the most 
effective means that we have at our disposal of treat- 
ing consumption. 

The difficulties of home treatment increase as the 
finances decrease. Remember that it is not so in- 
expensive as it seems; although you are not pay- 
ing out a certain definite sum each week for board, 
some one is paying the bills just the same. The 
advantages of home treatment are as follows : — 

i. There is no need of breaking up home and 
family. 

2. The patient may be happier and more con- 
tented. 

25 



26 CONSUMPTION 

3. If he gets well, he does so in his own and not 
a different climate. His chances therefore of keep- 
ing well in this climate are better. 

4. There is no radical and dangerous sudden 
change which the sanatorium patient undergoes 
on leaving the institution to return home. 

The disadvantages of home treatment may be 
summed up as follows : — 

1. There are no strict rules and regulations. 
There is a constant temptation to do too much and 
to do the wrong things. 

2. There is not the strict and constant medical 
supervision which exists in the well-run sanatorium. 

3. The great help provided by the example of 
what others are doing who have the same disease 
and who are getting well, is lacking. 

4. The climate, air and surroundings are rarely 
so good as at a sanatorium or health resort. 

5. It is often more difficult to sleep outdoors 
and to lead the strict sanatorium existence at home, 
especially in a large city, on account of publicity, 
etc. 

This, in my opinion, is a fair statement of the rel- 
ative advantages and disadvantages of home treat- 
ment. Home treatment as carried on by the men 
to whom I referred above, Dr. Minor and Dr. 
Pratt, has many of the advantages and few of the 
disadvantages. Such men, however, are rare. 
Home treatment as it is usually carried on by busy 
general practitioners falls very far short of this. 
The patient with ample means, who can afford a 



HOME TREATMENT 27 

good sleeping porch, nurses, and constant high-class 
medical attendance may do very well at home. In 
most instances, I think it dangerous for those in 
poor or even moderate circumstances to attempt it. 
The essentials of home treatment are as fol- 
lows : 

1. Outdoor living and sleeping. This will be 
considered in detail in the next chapter. 

2. Persistent, absolute and prolonged rest until 
all symptoms, fever, high pulse, cough, sputum, loss 
of appetite, etc., subside and then graduated exercise 
under strict medical supervision. 

3. Diet up to the limit of digestion, according to 
no hard and fast rule, but to suit individual needs. 
Diet in consumption will be taken up in a later chap- 
ter. 

4. Faithful and persistent attention to details. 

5. A competent physician who is willing to spend 
the time to attend to every detail, and who knows 
how to do so. 

It will be readily seen that it is not easy to meet 
all these qualifications of proper home treatment. 
In many instances, however, it seems the wise course 
to pursue. As a general rule, when home treatment 
is decided upon, a preliminary stay at a sanatorium 
or health resort if only for a short time will be of 
immense value in instructing the patient to carry on 
proper treatment at home. 



CHAPTER VIII 

HOW TO LIVE AND SLEEP IN THE OPEN AIR 

By Thomas Spees Carrington, M.D. 

Published with the permission of The National As- 
sociation for the Study and Prevention of Tuber- 
culosis. 

introduction 

Consumption, or tuberculosis, is a disease of the 
lungs which is taken from others and is not simply- 
due to catching cold. It is generally caused by- 
germs, known as tubercle bacilli, which enter the 
body with the air breathed. The matter which con- 
sumptives cough or spit up usually contains these 
germs in great numbers, and if those who have the 
disease spit upon the floor, walls or elsewhere, the 
matter will dry, become powdered, and any draught 
or wind will distribute the germs in it with the dust 
in the air. Any person may catch the disease by 
taking in with the air he breathes the germs spread 
about in this manner. He may also contract the 
disease by taking into his system the germs con- 
tained in the small drops of saliva expelled by a 
consumptive when coughing or sneezing. It should 

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HOW TO LIVE IN OPEN AIR 29 

be known that it is not dangerous to live with a con- 
sumptive if the matter coughed up by him is prop- 
erly disposed of. 

Consumption may be cured at home in many in- 
stances if it is recognized early and proper means 
are taken for its treatment. When a member of a 
family is found to have consumption and cannot be 
sent to a sanatorium, arrangements for taking the 
cure at home should be made as soon as the disease 
is discovered. 

The following directions are published to help 
persons to carry out the open-air treatment in their 
own homes. Many families are unable to make 
any great change in their mode of living and can- 
not afford to fit up porches and buy extra bedding 
or warmer clothing. A number of the suggestions 
given here are very simple and inexpensive, and will 
help those who would like to use what they have 
at hand in making an outfit for outdoor life. 

It is important, in the treatment of tuberculosis, 
to breathe air that is fresh and pare, to eat an abun- 
dance of good food, to stop heavy work and worry, 
and to take a bodily and mental rest by lying down 
before and after the noon and evening meals. To 
obtain the first, the patient must live out of doors. 
This means that as many hours of the day and 
night as possible should be spent in the open air, 
and in order to carry out this treatment some place 
must be provided which is not only protected from 
wind, but also from rain and snow, as nothing ex- 
cept the most severe cold weather should prevent 



30 CONSUMPTION 

the patient from living and sleeping there. The 
outdoor shelter should be large enough for a bed, a 
reclining-chair and a table. It should overlook 
pleasant and sanitary surroundings if possible, as 
it is to be the home of the patient for months, and 
will give better results if comfortable and attractive. 

HOW TO TAKE THE OPEN-AIR TREATMENT IN A 
TENEMENT HOUSE 

Tenement house dwellers and persons living in 
apartment houses in large cities should make every 
effort possible to give the open-air treatment to a 
member of the family who contracts tuberculosis. 
First, consider the possibility of moving into the 
suburbs or nearby small towns. If this cannot be 
done, try to obtain from the landlord the use of the 
roof, and build a small shack there as described 
later on in this chapter. If this is beyond the 
means of the family, use one room with a window 
opening on a street or large court for the patient, 
and then place the head of the bed beside the window 
and cover it with a window tent. The cost of 
a window tent is about $10.00, and if it cannot be 
obtained, take two large, heavy cotton sheets, sew 
them together along the edge, tack one end of the 
double sheet to the top of the window casing and 
drop the lower end over the outer side of the bed, 
fastening the bottom of the sheet to the bedrail with 
tape. There will be enough cloth hanging on each 
side of the window to form the sides of the tent, 
and these should be fastened to the window casings. 







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A window tent can be made at home for about $3.00 
by using 12 or 15 yards of heavy denim or light 
canvas. One straight piece of denim should be hung 
from the top of the window casing to the outer side 
of the bed, and the openings between this and the 
side window casings filled in with sides cut and 
fitted from the balance of the cloth. By these meth- 
ods the patient gets fresh air from the window and 
the room is kept warm in cold weather as a place 
for dressing and toilet purposes. During mild and 
warm weather, the tent can be removed and the 
window kept open both at top and bottom. 

The flat roofs of tenement and apartment houses 
in large cities should, if possible, be used as a breath- 
ing place by the tenants. Shacks or cabins can be 
built upon them at small cost and make an econom- 
ical and easily provided shelter. 

HOW TO BUILD A SMALL SHACK OR CABIN ON A FLAT 
ROOF IN THE CITY 

Two by four timbers should be used for the frame 
and siding boards for the back and sides. The 
front of the shack should face slightly to the east 
of south and be left open, but arranged with a can- 
vas curtain, tacked on a roller so that it can be 
closed in stormy weather. The shack can be built 
cheaply with rough boards and the roof cov- 
ered with tar paper or other roofing. As the vast 
extent of flat roof space in all cities and in many 
towns should be used for outdoor living and sleep- 
ing, detailed plans for building a shelter on them 



32 CONSUMPTION 

and a list of material, together with the approxi- 
mate cost, are given. The list will be understood 
by any carpenter, and when the shelter must be built 
economically it is advisable to confer with the 
neighborhood carpenter, rather than place the con- 
struction in the hands of a contractor or builder. 

LIST OF MATERIAL AND ESTIMATE OF COST FOR CON- 
STRUCTING A SMALL OPEN-AIR SLEEPING SHACK 
ON A CITY ROOF OR IN A COUNTRY YARD 

328 feet of rough lumber as follows, at $30.00 
per M, $9.84. 

4 pieces, 2 inches by 4 inches by 12 feet, sills. 

5 pieces, 2 inches by 4 inches by 12 feet, floor 
joists. 

14 pieces, 2 inches by 3 inches by 14 feet, studs. 
5 pieces, 2 inches by 3 inches by 12 feet, plate. 
1 piece, 2 inches by 6 inches by 12 feet, plate 
(front). 

1 piece, 2 inches by 8 inches by 12 feet, rail for 
sliding sash. 

9 pieces, 2 inches by 4 inches by 14 feet, rafters 
and rafter tails for front eaves. 
300 feet of novelty siding for walls at $30.00 

per M $ 9 . 00 

250 feet of shiplap roof boards at $26.00 

per M 6.50 

200 feet of 7-8 inch common flooring at 

$32.00 per M 6.40 

One-half roll Neponset Red Rope Roofing at 

$5.00 per roll 2.50 










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10 pieces of i-inch half round for roofing at 

1 cent per foot 1 . 40 

1 canvas curtain on roll 5 . 00 

4 sliding sash, 3 feet by 3 feet, at $2.00 8.00 

1 casement sash and frame, 2 feet by 2 feet, 

at $2.00 2 . oo 

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Strips for sliding sash 1 . 00 

Paint ...... 5.00 

$61.64 

Labor 2 5»oo 



$86.64 
Note. — Canvas can be bought by the yard and a 
curtain made at home. 

HOW TO ARRANGE A PORCH ON A HOUSE IN 
THE COUNTRY 

If the family lives in a small town or in the coun- 
try, it will usually be found that a porch is the most 
convenient way of providing open-air quarters. In 
selecting a site for the porch, it is well to remember 
that the patient should be placed out of doors in 
such a way that the cure can be taken with comfort 
at all seasons of the year. For the winter months 
the best place is on the south side of the house, as 
there will be found the greatest amount of sunshine. 
If this cannot be done, choose first the east, or sec- 
ond the west side, but not the north side except as 
a last resort, for it is a w T indy and cold position in 



34 CONSUMPTION 

winter. The back of the house is usually better 
than the front as the porch cannot be seen from 
the street, but what is of the most importance is to 
find a sheltered spot protected from the wind, for 
the wind is much harder to bear than even intense 
cold. When a house has permanent verandas and 
the family cannot afford the expense of providing a 
special porch for the patient, the permanent veranda 
on any floor may be used and privacy and protec- 
tion obtained by putting up canvas curtains or bam- 
boo screens. 

If a special porch for winter use is to be built, 
place it on the south side of the second story of the 
house, with an entrance into a room which can be 
used by the patient. For a passageway to the porch 
cut one of the windows down to the floor and put 
in a door 3 feet 8 inches wide, so that the bed can be 
rolled from the room to the porch without difficulty. 
If the room is not heated by some other means, a 
stove should be used and the air kept warm, so that 
the patient may have a comfortable place for dress- 
ing, eating, and to enter when chilled. Build the 
porch out from the door 10 feet wide by 10 feet 
long and 7 feet or more in height from floor to 
ceiling. Place glass and sash on the side of the 
porch most exposed to the weather, and hang can- 
vas curtains on rollers to enclose the open sides in 
stormy weather. Lay the floor with narrow 
spruce boards, using white lead and oil to fill in the 
cracks, at a grade of 1 inch to 5 feet, so that water 
will not stand during stormy weather. A porch of 



HOW TO LIVE IN OPEN AIR 35 

this kind can be built in small towns and in the 
country for from $50.00 to $100.00, the cost de- 
pending upon the class of material used and the way 
the porch is finished. 

HOW TO BUILD A CHEAP PORCH 

A useful porch can be built for $12.00 or $15.00 
with cheap or second-hand lumber, and if only large 
enough to receive the bed and a chair will still be 
effective for the outdoor treatment. The roof can 
be made with a canvas curtain or a few boards and 
some tar paper. The end most exposed to the wind 
and rain and the sides below the railing should be 
tightly boarded to prevent draughts. A window 
can be used for the approach, but it will be more 
convenient if it is cut down to the floor and a small 
Dutch door put in below the window-sash. Second-. 
and third-story porches are supported from the 
ground by long 4 by 4 posts, or, when small, they 
can be held by braces set at an angle from the side 
of the house. 

HOW TO PROVIDE A SHELTER FOR THE SUMMER 
AND FOR HOT COUNTRIES 

Consumptives need a good shelter in tropical 
countries and protection during the summer months 
in northern climates. A porch should be placed on 
the side of the house where the direct rays of the 
sun will not strike it during the middle of the day, 
and tents or shacks placed under shade-trees or in 
the shadow of large buildings. 



36 CONSUMPTION 

Awnings which jut out from the roof of a porch 
or shack are used for shade, and Japanese drop cur- 
tains made of long strips of bamboo for privacy, 
as they do not stop the current of air. 

In places where the streets are not watered, a 
hose should be used to lay the dust in front of the 
house, and the floor of the porch or shack sprinkled 
once or twice each day to cool the surrounding air. 

The open sides of the shelter must be screened 
from the floor to the roof with wire netting as a 
protection from flies and mosquitoes, and when this 
is impossible, a mosquito-bar made of cheese-cloth, 
netting or scrim should be hung from the roof or 
laid over barrel-hoops attached to the head and foot 
of the bedstead. 

TENTS AND TENT HOUSES 

Tents and tent houses can be used as a shelter in 
warm, dry climates and for the summer months in 
northern countries, but they are not very satisfac- 
tory for winter use in cold climates. 

In order to make a tent comfortable for a sick 
person, it should have a large fly or double roof 
with an air space between, a wide awning in front 
where the patient can sit during the day, a board 
floor laid a few inches above the ground and the 
sides boarded up two or three feet from the floor. 

THE BED AND BEDDING USED IN OUTDOOR 
SLEEPING 

An ordinary iron bedstead with woven wire 
spring 3 feet 6 inches wide and a moderately thick 




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HOW TO LIVE IN OPEN AIR 37 

mattress are all that are necessary except for very 
cold weather. A bedstead which can be rolled 
about easily is a great convenience, and should 
therefore be fitted with small rubber-tired w r heels or 
casters. A good hair mattress is most desirable, but 
when it cannot be obtained, a cotton- felt mattress 
can be bought for as low as $4.00, or a wool mat- 
tress for about $10.00. In northern climates, where 
cold weather must be expected, two mattresses with 
several layers of newspaper between them are often 
used. Over the mattress place an old blanket or a 
cotton bed-pad, the same width as the mattress, and 
on this the ordinary bed-sheets or blanket-sheets. 

BED COVERS USED IN OUTDOOR SLEEPING 

Persons who like heavy bed covering may use 
blankets, placing as many layers over the bed as de- 
sired for warmth. Those who cannot stand heavy 
covering can use down comforts, as they are very 
warm but light. If these are too expensive, lamb's- 
wool or cotton-filled comforts can be bought, or the 
material for wool or cotton quilts can be obtained 
for about $2.00 and warm, satisfactory covering 
made in the home. Very cheap, light, but warm 
covering can be made by using paper blankets placed 
between two thicknesses of outing flannel or bed 
covers. These paper blankets are sold for 50 cents 
each and wear for about six months. A woolen 
horse blanket with an outside of canvas can be used 
as a covering to protect the bedding in wet and 
stormy weather. 



38 CONSUMPTION 

SLEEPING-BAGS 

In very severe weather a sleeping-bag may be 
used for patients who are very susceptible to the 
cold. These bags can be bought at department 
stores for $15.00 upward, or can be made at home 
by sewing blankets together around the edges, leav- 
ing the top open. In making a bag, use as many 
layers as may be desired, but place the same number 
of thicknesses on both sides of the bag. The 
blankets should be 7 feet long by 4 feet wide. 

ARRANGEMENT OF PILLOWS IN OUTDOOR 
SLEEPING 

Two pillows should be used in preparing the bed 
before retiring. Place them in the form of an in- 
verted V, with the apex at the top of the bed and 
the head at the point where the two pillows meet. 
This position allows the shoulders to nestle between 
the pillows and protects them from the cold wind 
which will otherwise find its way under the bed- 
clothes when the patient lies on his side or turns 
over. 

HOW TO PREPARE THE PATIENT FOR THE NIGHT 

In cold weather the outdoor sleeper should get 
into the bed in a warm room and have someone roll 
him out of doors. When this cannot be done, use a 
warm dressing-gown in going back and forth from 
the dressing-room to the porch, and warm the bed 
by placing in it for a few minutes before retiring, 



HOW TO LIVE IN OPEN AIR 39 

a hot-water bag, hot bricks, soap-stones or bottles 
filled with hot water. In some instances it is well 
to leave a- hot stone or bottle wrapped in flannel at 
one corner of the bed, where it will throw off heat 
slowly during the night. 

In tucking in the patient at night, all covers ex- 
cept the top blanket or comfort should be tucked 
in under the bed-pad which lies on the mattress. 
The topmost cover is then tucked under the mattress 
to keep the under covers from sliding off when the 
sleeper is restless. This method of tucking-in 
forms a sort of sleeping-bag with the bed-clothes, 
known as the Klondyke bed, and prevents the cold 
air from reaching the body. 

CLOTHING WORN AT NIGHT 

The night clothes worn by the outdoor sleeper 
during the winter depend largely upon the strength 
of the patient. Some persons need much more 
than others, but even the weakest can usually keep 
warm if they have blanket-sheets and hot bottles. 
A woolen undershirt, a sweater, and a long outing 
flannel nightgown or bathrobe are usually worn, 
but in very cold weather some patients wear a pair 
of drawers made of flannel, a pair of bed-socks or 
knitted slippers and a woolen abdominal bandage. 

HOW TO PROTECT THE HEAD FROM DRAUGHTS 

The head of the bed should be shielded from the 
wind or a strong draught by placing it close to the 
protected end of the porch, or by covering it with a 



40 CONSUMPTION 

canvas hood supported on a barrel-hoop attached to 
the bedstead or hung by a rope from the ceiling. 
The patient can wear a knitted skull-cap long 
enough to be pulled down to the end of the nose 
and over the ears, or a knitted helmet which covers 
the whole of the head, face, and neck, with the ex- 
ception of a small opening for the nose and mouth. 
A hood shaped like an old-fashioned sunbonnet is 
very comfortable, and can be made at home from 
eiderdown or outing flannel by using as many thick- 
nesses as may be needed. Never cover the head 
zvith the bed-clothes. If the nose grows cold, use a 
small piece of flannel, held by elastic bands from the 
ears, to cover the top, or a piece of cotton held in 
place by a strip of adhesive plaster. Care should 
be taken not to interfere with the inhaling of fresh 
air or to allow the breath as it is expelled from the 
nose or mouth to come in contact with the cloth and 
form icicles. Chapping of the face during the night 
can be prevented by using cold cream or vaseline 
about the nose and lips. 

CLOTHING FOR DAY USE 

The clothing for use during the day when the pa- 
tient is up or sitting in a reclining-chair should be 
of light weight but warm. Underclothes of half 
cotton and wool or linen mesh, and a sweater which 
buttons in front, with the ordinary outer clothes, 
are usually worn. The overcoat for men, women, 
and children should be of fur if possible, as even the 
cheapest of skins are warmer than any other kind 




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of garment. If a new coat cannot be bought, a 
heavy cloth overcoat will give good protection, and 
be much warmer if it has a high, soft collar. 
Leather leggins and woolen tights are used as extra 
garments, and are a great comfort when taking ex- 
ercise on cold days. 

HOW TO PROTECT THE HANDS 

Patients who wish to use their hands while sitting 
out of doors in cold weather can wear thin, well- 
fitting cotton gloves. These are used by army men, 
and can be bought for thirty cents a pair. Over 
them should be drawn a knitted woolen glove with 
the ends of the fingers and thumb cut off and bound 
to prevent unraveling. For ordinary protection, 
when not at work, a heavy fur or woolen mitten 
should be worn with long, woolen wristlets. Never 
use tight gloves of any kind in cold weather, as 
they restrict the circulation of the blood and cause 
the hands to grow cold. 

HOW TO PROTECT THE FEET 

Use woolen stockings, and if they cause irritation, 
wear a cotton stocking next to the skin. Sometimes 
two or more pairs of woolen stockings are necessary 
in very cold weather, but they must always be large 
enough to fit loosely. Felt shoes are warm and 
light, and are much used. Soft leather shoes cov- 
ered by large fur-lined leather shoes are very warm 
and comfortable, but are expensive, as they must 
be made in a set, to order. Foot-muffs should be 



42 CONSUMPTION 

used in sitting out during a cold day. They are 
made of fur or of cotton quilts sewed up like a bag, 
into which the feet can be placed. On very cold 
days the muff can be placed in a wooden soap-box 
with hot bricks beside it, and newspapers wrapped 
about the muff to fill in the empty space. 

CHAIRS FOR DAY USE 

An easy-chair is a great comfort to the patient 
during the day. A steamer chair is easily obtained 
and gives good service, and the canvas chair with a 
wooden frame can be bought for $1.00, or the cane- 
seat extension-chair for $2.50 up. A more durable 
chair is made for this purpose with an iron frame, 
costing about $25.00, which can be transported and 
used in a rough manner without danger of break- 
age. To prevent the cold currents of air reaching 
the patient from below, the chair must be covered 
with some thick, closely woven, warm material. A 
fur rug is the best for this purpose, but several lay- 
ers of blankets and newspaper will answer and are 
more economical. 

TABLE FOR WORK AND AMUSEMENT PURPOSES 

The patient should have a table handy on which 
to keep books and other things used for amusement 
or work. An adjustable table, the top of which the 
patient can swing before him or away, is a great 
convenience, and can be used as a book-rest when 
the hands are under cover. 



HOW TO LIVE IN OPEN AIR 43 

GENERAL DIRECTIONS FOR THE CARE OF THE 

PATIENT 

The directions for the care of the patient are not 
intended in any way to take the place of a physi- 
cian's orders. Every consumptive should consult a 
doctor, and these suggestions are given to help the. 
patient carry out his directions. Rest is a most 
important part of the open-air treatment, and exer- 
cise must be regulated by the doctor. Always have 
at hand an extra wrap, and never remain out if 
chilled. Cold weather should have a bracing effect, 
and when it does not, go into a warm room and get 
a hot drink, preferably milk, remaining indoors until 
comfortably warm. When going out again use 
more wraps, and keep behind a shield or screen that 
breaks the force of the wind. Always be cheerful 
and hopeful; never waste your strength in anger or 
by being cross. Lead a temperate life, go to bed 
early and get up late ; do not use alcohol in any form 
except when prescribed by your doctor. Do away 
with tobacco if possible, and use only weak tea and 
coffee in small quantities. Never swallow the mat- 
ter coughed up, but always destroy every particle 
by spitting in a paper or cloth which can be burned. 
Never allow the hands, face or clothing to be soiled 
by sputum, and if this happens by accident, wash 
the place soiled with soap and hot water. Men who 
have consumption should not wear a moustache or 
beard unless it is trimmed close. Particular care 
must be taken, when sneezing and coughing, to hold 



44 CONSUMPTION 

in the hands before the face a cloth which can be 
burned. Soiled bed-clothes, nightdresses, other 
washable garments, and personal linen should be 
handled as little as possible until they are boiled 
prior to their being washed. The dishes used by the 
patient must be boiled after each meal. 

All the above means care and work, but must be 
done both as a protection to the household and in 
order to bring about a speedy cure for the patient. 



CHAPTER IX 

TREATMENT IN A LOCAL OR NOT FAR DISTANT 

SANATORIUM. HOW TO GET THERE 

AND WHAT IT COSTS 

As previously stated above, I believe that a stay 
at a well-run sanatorium or its equivalent, even 
though very short, merely a month or two, is a most 
valuable help in carrying out subsequent treatment 
at home or elsewhere. There are four reasons why 
people go to sanatoria : 

1. To learn how to live so as to be able to carry 
on treatment faithfully and intelligently at home. 

2. To get cured of their disease, if possible. 

3. To stay cured, which is a very different propo- 
sition from merely reaching the stage when the 
process is called " arrested." 

4. To learn how to help others and to keep them 
from getting sick. 

There are sanatoria, public or private, in every 
State in the country. The cost of board varies from 
fifty to one hundred dollars a week down to nothing. 
For the vast majority of patients, only those insti- 
tutions where the cost of board is very moderate or 
low are at all available. In some states there are 
no state or local low-priced sanatoria, and the pa- 

45 



46 CONSUMPTION 

tient, if in m'oderate or poor circumstances must 
make other arrangements. The difficulty usually 
consists in the fact that the average busy general 
practitioner has only the vaguest ideas on the sub- 
ject, and can give no very definite instructions to his 
patient as to what to do or how to do it. At some 
state sanatoria only incipient cases and at others 
only those in the advanced stages are admitted, 
while a few take patients in all stages. Some de- 
mand payment of board from every patient, there 
being no provision for free treatment ; at others the 
cost is four or five dollars only if the patient is able 
to pay it, while at still others, treatment is free for 
all. To some state institutions patients are admit- 
ted after making application on a blank, which any 
physician may fill out ; others have special examin- 
ing physicians who must see the applicant and decide 
as to his or her fitness to enter. Some sanatoria are 
at considerable altitude, others at nearly sea level. 
The cost of fares and the distance from home should 
be definitely known. All these points are important 
ones and of great practical value to the patient and 
his family and friends. The problem is how to find 
them out. 

This is not difficult if the way is known. Those 
who care to consult a specialist and get definite in- 
formation, and can afford to do so, should not hesi- 
tate to ask their family physicians to be referred to 
such a person. The very poor have this advantage, 
in that they can at any time go to a tuberculosis dis- 
pensary or clinic (the name and location of such 



TREATMENT IN A SANATORIUM 47 

dispensary being found on inquiry from the State 
Board of Health or Anti-tuberculosis Association, 
as mentioned before) and there get the best of ex- 
pert advice. Those who cannot do either of these 
things, however, should write to the National Tu- 
berculosis Association, 105 East 22nd Street, New 
York City, for information or means of obtaining 
information on every phase of this subject; in addi- 
tion to this a letter addressed to the Journal of the 
Out Door Life, at the same address as above, will be 
printed, with a full answer, in the next issue of this 
most admirable magazine. From the same sources 
information in detail as to private sanatoria and 
health resorts can be obtained. 

Take, for example, the case of a patient, or friend 
or relative of a patient, who wished to find out about 
entering one of the state sanatoria in Massachusetts. 
He would first write to the State Department of 
Health at the State House in Boston. From there 
his letter would be referred to the Massachusetts 
Tuberculosis Commission, at 3 Joy Street, Boston. 
The Secretary of this Board would at once write to 
the sender of the letter, answering the questions in 
detail, and enclosing suitable printed matter, circu- 
lars of information, etc. If necessary, a personal in- 
terview could later be arranged. From the same 
source application blanks and all details relating to 
the institutions under this Board could be obtained. 
Some such board or commission or source of infor- 
mation exists in every state, whose services are at 
the disposal of its citizens. 



48 CONSUMPTION 

Private sanatoria cost more than state institutions 
and offer certain evident advantages. The price of 
board at the moderate priced ones ranges from $12 
to $25 a week. There is, of course, more individual 
attention given to each patient, but, on the other 
hand, he has more freedom and is more likely to in- 
terfere with his progress by attempting too much. 
Whether at a large or a small institution, much de- 
pends on the mental attitude of the patient toward 
the disease, the doctors and the institution itself. 
At the Massachusetts sanatoria, patients are divided 
into two classes, the " Hospital " and " Sanato- 
rium " classes. To the first belong those who look 
upon the sanatorium merely as a first-class boarding 
house, who will not co-operate with the doctors, who 
refuse to follow the details of treatment, and who 
break rules whenever they can do so without get- 
ting found out. These patients almost invariably 
do poorly. To the other class belongs the opposite 
type of patient who really wishes to get well and 
in so doing is willing to sacrifice some personal com- 
fort and convenience in order to adhere rigidly to 
every slightest detail prescribed by the physicians. 
These patients do not always get well, but they do 
far better than the others. A card bearing the fol- 
lowing suggestions is given to every patient before 
admission to a Massachusetts sanatorium. It would 
be well for everyone affected with this disease to 
study and digest the advice here given. 



TREATMENT IN A SANATORIUM 49 

ADVICE TO PATIENTS ABOUT TO ENTER A 
SANATORIUM 

You are about to enter a sanatorium in order to 
regain your health. Please read over the following 
suggestions carefully : 

1. Remember that your disease — tuberculosis 
— is a chronic one, and that it is cured only by pa- 
tience, perseverance, and faithful attention to details 
over a long period of time. 

2. Remember that you are going to the sanato- 
rium not only to cure your disease or to arrest its 
progress but also to learn how to live so as to 

KEEP WELL AFTER YOU LEAVE THE SANATORIUM. 

3. Bear in mind always that unless you do 
learn how to live while at the sanatorium and follow 
out these rules of living after you leave you will be 
very apt to have a relapse of your disease later on. 

4. Remember that w T hile at the sanatorium you 
must obey certain rules and regulations. These are 
absolutely necessary. Nothing unreasonable will be 
asked of you. The more closely you adhere to 
these rules and do what the doctor says, the better 
are your chances of getting well. 



CHAPTER X 

SARANAC LAKE. WHERE IT IS, WHAT IT OFFERS 

TO THE CONSUMPTIVE, AND HOW TO GET 

THERE 

I am taking Saranac Lake and the sanatorium 
there situated as the best example I know of a health 
resort where patients of moderate means as well as 
those who are better off can find high-class ac- 
commodations and receive the best of treatment. 
There are other places equally good, such as Liberty, 
New York, or Asheville, South Carolina. I shall 
describe in detail the village of Saranac Lake itself 
and what it offers to consumptives because I believe 
that in many ways it has more advantages and 
fewer disadvantages than any other place I know. 
I send my own patients there, and, when visiting 
Saranac Lake myself, I find a constant source of in- 
spiration and renewed vigor in this little mountain 
village. 

Over twenty-five years ago, a New York physi- 
cian, Dr. Edward L. Trudeau, was told by his med- 
ical advisers that he had consumption and must at 
once leave the city. This he did, giving up every- 
thing that meant to him success in his profession. 
He went to the village of Saranac Lake and there 

So 



SARANAC LAKE 51 

spent the winter nearly alone, living an outdoor life. 
To the surprise of his friends he rapidly improved. 
He finally started a little sanatorium for a few pa- 
tients, so that other sufferers might profit by the air 
and the climate and lead the life which had proved 
such a boon to him. This was the beginning of the 
Adirondack Cottage Sanatorium, — now a large, 
flourishing and famous institution. Despite his 
tremendous handicap, Dr. Trudeau has done a great 
work and has brought hope, health and happiness 
to countless victims of tuberculosis. 

The village of Saranac Lake is in the Adirondack 
Mountains, north of Albany, an all night's ride from 
New York or Boston. The elevation of the town 
itself is about 1600 feet, but it is surrounded by 
some of the highest Adirondack peaks. There is a 
permanent population of over 6,000. The climate 
is a typical one of that region — cold and dry in 
winter and fairly warm, though rarely uncomfort- 
ably so, in summer. The winter, spring and fall 
are the popular months, March is apt to be wet 
and stormy. There is not as much sunshine as 
there is in the South or the West, but as much as 
or more than in New England and the Northeast. 
The air is dry and intensely stimulating. One can 
sit out of doors with the temperature far below zero 
without discomfort. In the summer, as in all such 
places, there are apt to be a few inLensely hot days, 
but for the greater part of the time one can be per- 
fectly comfortable. 

The cost of board at the sanatorium itself is $8 



52 CONSUMPTION 

a week. Only early and favorable cases are taken 
at this institution, for whom there are special exam- 
iners in New York, Philadelphia, Boston and other 
large cities of the East. The names and addresses 
of these physicians can be obtained by writing to the 
sanatorium itself, or to any local anti-tuberculosis 
association. The great majority of patients are not 
in the sanatorium, but live outside, in or near the 
village, in private boarding houses, or keeping house 
for themselves. One cannot get good board at 
Saranac Lake for less than $14 a week; the patient 
can pay as much more than this as he cares to spend. 
The cost of medical attendance is very low. 

Saranac Lake, which is entirely distinct from the 
village of Saranac, can be reached from New York 
or Boston by a through night sleeper which leaves 
late in the afternoon and arrives at the village at 
about six the next morning. From Montreal and 
the North and from the West there are also through 
trains. No one should go to this place unless 
definite arrangements have been made beforehand. 
The patient's local physician should write to one of 
the Saranac Lake doctors and state in detail the 
medical side of the case; the patient himself or his 
family should also write, giving details as to 
finances, price to be paid for board (always remem- 
bering that this is a question of mbnths and not 
merely a few weeks), the exact date of arrival, etc. 
Until all such arrangements are definite and clear, 
the patient should not start on his journey. On ar- 



SARANAC LAKE 53 

rival in the morning, he should take a carriage (the 
fares are very low) to a hotel, where he can get 
breakfast and rest for a while. Unless it has been 
arranged beforehand, he should then get in touch 
with the doctor who is to have charge of the case 
and plan to meet him or be directed to the boarding- 
house or home where he is to stay permanently. 
All questions concerning every detail of life at Sara- 
nac Lake will be promptly and accurately answered 
by writing to the Secretary of the Saranac Lake So- 
ciety for the Control of Tuberculosis. 

One is very likely to think of Saranac Lake as a 
place where wan- faced invalids abound. Nothing 
is further from the truth. It is true that many sick 
people go there, but on the whole, the atmosphere 
of the place is cheerful, bright and optimistic. I 
well remember a friend, himself a patient, who had 
been at Saranac for years, saying to me : u Doctor, 
we're all chipped and broken pottery here, but we 
rattle around and make a very cheerful noise after 
all ! ,: Patients spend their daily stint of eight hours 
out of doors without complaining or grumbling. 
The first week or so may be hard, but after this 
the force of the example of what everyone else is 
doing is so strong, and the results are so good that 
one accepts the situation without a murmur. The 
honor system prevails. It is easy to break rules 
and regulations, and to disobey the doctor if you 
want to; but you don't want to. This is why so 
many people are cured up there who never would 



54 CONSUMPTION 

have been cured at home, simply because they could 
never have stood the strain of carrying on by them- 
selves the rigid sanatorium regime. 

I do not wish to give the impression that Saranac 
Lake stands alone and that there are not many other 
places where as good results can be obtained. I take 
Saranac merely as an example. I do feel, however, 
that it offers more for the money invested to those 
who can go there than any other place I know. 



CHAPTER XI 

COLORADO AND THE WEST 

I have never sent a patient with active pulmonary 
tuberculosis West or Southwest unless the patient 
had enough money so that he did not have to worry 
about the expense. Even so, the patients whom I 
have told to go to Colorado or elsewhere in the West 
form a very small and limited class. My reasons 
for feeling this way are as follows : — 

i. The great cost of transportation to the West 
and high price of board at the sanatoria. Twenty- 
five dollars a week is a very moderate price for 
board, while at many institutions the price is fifty 
or over. 

2. The altitude is too high for patients with weak 
hearts, and dangerous for those with a tendency to 
hemorrhage. 

3. The great distance from home and the impos- 
sibility of visits from relatives and friends leads to 
homesickness, loneliness, and mental discontent. 
These are great handicaps in fighting tuberculosis. 

These are the chief objections to life in the far 
West for the average consumptive. There are, 
however, certain advantages which must be given 
due weight. The climate is remarkable in many 

55 



56 CONSUMPTION 

ways; there is sunshine and plenty of it winter and 
summer, all the year round, and air so dry that it 
is vastly easier to live an outdoor life with comfort 
in the winter than it is in New England or even at 
Saranac. This is a most important consideration. 
While the altitude is dangerous or harmful to some 
patients, there is absolutely no doubt that for those 
able to stand it, it is of immense help. As far as 
the comparative isolation is concerned, there is a 
certain class of patients to whom separation from 
friends and relatives is a great advantage and who 
rather relish the independent Western life. All 
these pros and cons must be carefully weighed and 
balanced one against the other in considering each 
case. The cost must always be borne in mind. 
Many people have been cured in the West and many 
have been hurried into a premature grave by going 
there. Do not go West unless 

(a) You are assured by competent medical advice 
that your heart will stand the strain and that the cli- 
mate is suited to your individual case. 

(b) You have $1000 in cash to spend on proper 
food and lodging. 

(c) You know of some good doctor and have a 
letter to him containing all details of your case. 

Above all, remember that even if you go West 
and do well there, you may never be able to come 
back to the denser air and lower altitude of the East. 
For further details as to sanatoria, etc., write to the 
sources previously mentioned. 



CHAPTER XII 

AFTER THE SANATORIUM, THEN WHAT? 

A properly conducted sanatorium, public or pri- 
vate, should prepare the patient for continued treat- 
ment or work after leaving the institution. Sana- 
torium treatment is as much for the future as for 
the present. To gain ten or twenty pounds in 
weight, to lose cough and sputum, etc., is evidence 
that the progress of the disease is checked. But 
unless the lessons learned at the sanatorium sink 
deep into the patient's mind and unless he fully real- 
izes that a few months at a sanatorium never really 
cured consumption, the gain he has made will soon 
be lost and the money he has already spent on him- 
self will be wasted. Therefore, long before the pa- 
tient leaves he should begin to think ahead and plan 
for the future ; he should consider the feasibility of 
outdoor sleeping at home and should be making in- 
quiries for proper work or occupation. He should 
consult his physician in regard to all these plans, es- 
pecially as regards rest and exercise. Mere fat is 
of no special value. A certain amount of increased 
weight is advisable, but this should be as much 
muscle as fat. Exercise in gradually increasing 
amounts should be taken until at time of departure 

57 



58 CONSUMPTION 

the patient is in good physical condition. It is well 
for the patient to bear in mind that a period of 
" post-sanatorium depression " is apt to follow the 
departure from the sanatorium. The sudden free- 
dom from supervision, rules and regulations, the 
doubt as to the future, which is often present in his 
mind, and the suddenly acquired burden of new re- 
sponsibilities may cause a sort of mental panic. 
This lasts only a short time, and then passes away 
permanently. 

The question is sure to come up as to what sort 
of work is best to do, and whether or not the pa- 
tient should go back to his old occupation. This de- 
pends largely on the following : 

(a) The condition of the patient and of his 
lungs. If the disease is still active, hard work of 
any kind is of course out of the question. 

(b) Exactly what the occupation he wishes to 
pursue involves as to hours, physical or mental 
strain, etc. In other words, is it one of the so-called 
" dangerous trades/' owing to dust, fumes, long 
hours, exposure to heat and cold, etc. ? 

(c) How the rest of the tw T enty-four hours dur- 
ing which the patient is not working is to be spent. 
I have often allow r ed a patient to return to his for- 
mer occupation, even if it were not a favorable one, 
on condition that he could sleep outdoors at night 
and during the rest of the day live under good hy- 
gienic conditions. 

(d) The financial situation and the difficulty in 
getting another job. When a patient is so situated 



SANATORIUM, THEN WHAT? 59 

that it involves no hardship for him to give up his 
old trade and seek a new one, even if he has to wait 
for it and then work at lower wages, it is certainly 
better to advise this course of action. But this is 
rarely the case. In the majority of instances, it is 
essential for the patient to get back to work and 
earn some money as soon as possible; likewise it is 
usually quite impossible for him to start in all over 
again and learn a new trade. It is a common thing 
for doctors to tell their patients to " get a light out- 
door job." It would be a good thing for these doc- 
tors to try for themselves to secure an outdoor job 
suitable for a consumptive or an ex-consumptive. 
Then they would not give such useless advice. An 
outdoor occupation is an excellent thing if it can be 
found. Most patients must get w T ell without one, 
however. 

Medical Supervision. There is no time when 
there is more need of sound medical advice than 
during the first six months or year after leaving 
the sanatorium. Most patients are only too anxious 
to leave behind them every trace of things medical. 
This is a dangerous course to pursue. Every pa- 
tient should go to his own local physician at once 
after leaving the institution, and should report to 
him regularly once a month during the first year 
and once every two or three months for several 
years. He will find the money thus spent in doc- 
tors' fees an excellent investment. The patient who 
does not do this runs a grave risk of having an 
early relapse. 



CHAPTER XIII 

TUBERCULOSIS IN CHILDHOOD 

Tuberculosis has been called a true children's dis- 
ease. This is because in almost every case infection 
with the germ of tuberculosis takes place in child- 
hood. It is an amazing state of affairs, but un- 
doubtedly true that by the time a child reaches his 
fourteenth year he has already become infected with 
tuberculosis. This does not necessarily mean dis- 
ease, as before stated; there is, fortunately, a vast 
difference between tuberculous infection and tuber- 
culous disease. The first simply implies that some- 
where in the body, causing no symptoms in the pres- 
ent and very likely to cause none in the future, there 
exists, tucked away in some gland or elsewhere, a 
tiny focus of tuberculosis. That this occurs has 
been proved by countless autopsies and other scien- 
tific investigations. The fact that the majority of 
us are well and strong and yet harbor these germs 
somewhere in our body is sufficient evidence that 
tuberculous infection does not necessarily mean sick- 
ness. 

Tuberculous disease should be applied to the con- 
dition when these germs are no longer latent and in- 
active, but are causing symptoms. These symptoms 

60 



TUBERCULOSIS IN CHILDHOOD 61 

in childhood are usually different from those in 
adults for the reason that actual disease of the lung 
itself is rare and occurs only in the late stages when 
the diagnosis is evident. In the early stages the 
process is confined to the lymph nodes, especially 
those at the root of the lung in which case the con- 
dition is called " bronchial gland tuberculosis.'' 
The only local symptom which parents should know 
is a peculiar paroxysmal cough like that of whoop- 
ing cough. The important symptoms are the 
" constitutional " ones. The more important con- 
stitutional symptoms are: 

(a) Loss of weight or strength or failure to 
gain in weight and vigor. 

(b) Debility, languor, listlessness, undue fa- 
tigue. 

(c) Pallor or anaemia. 

(d) Slight fever. 

(e) Frequent colds without adequate cause. 

(f) A poor or capricious appetite. 
Remember that while other things may cause 

each and all of these symptoms, that tuberculosis 
may and often does cause them. Take the child 
to your doctor and have him examined. If he fails 
to gain or gets worse, consult a specialist or go to 
a special dispensary where the child can be seen by 
experts in this line. Do not attempt to diagnose 
or treat the child yourself. Do not put off going to 
your doctor, but do so at once. 



CHAPTER XIV 

HOW PARENTS CAN HELP IN THE PREVENTION AND 
CURE OF TUBERCULOSIS IN CHILDREN 

Remember that in the case of children as in 
adults, good health should come first always. This 
is especially true in children. In a few cases adults 
can take risks and often have to do so, and continue 
at their work although in poor health. With adults 
the doctor often has to compromise and demand 
only such measures as can be carried out along with 
the patient's regular occupation. In the case of 
children there should be no compromise. Except 
in crowded city districts, the ailing child should be 
at once removed from school and " put out to 
grass," i. e., made to live out of doors in fresh air 
and sunshine. In the large cities, where there is 
little or no opportunity for fresh air and sunshine, 
unless he can be sent out into the country, the child 
should be sent to an open air school or some such 
institution. Always remember that health comes 
first, and that schooling is purely secondary. 

Outdoor sleeping is hard to arrange for children 
unless there is a separate house in the country or 
suburbs, where a suitable sleeping porch can be ar- 
ranged. The details of how to sleep outdoors have 

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HOW PARENTS CAN HELP 63 

already been given in a previous chapter. Sun- 
light is a healing power of great value. Exactly 
in what way it acts we do not know, but we do 
know that exposure of the child's body to the sun's 
rays is of great benefit, even at low altitudes where 
the air is not so rare and pure as in the mountains. 
It is .only comparatively recently that " sunlight 
treatment " or " heliotherapy " has been carried on 
to any great extent. It is bound to become more 
widely used as people realize its benefits. It should 
be carried on only under a physician's direction. 

The diet should be carefully supervised. In 
feeding children, as with adults, bear in mind that 
it is what can be digested and is digested and assim- 
ilated and not that which is taken into the stomach 
that is of value. Three meals a day, with a glass 
of milk at each meal, and if the child is below 
weight, light lunches in the middle of forenoon and 
afternoon, is the basis of diet in such conditions. 
No tea or coffee should be allowed. Be sure the 
teeth are in good condition. Take the child to the 
dispensary or the dentist and have this attended to. 

Cold sponge baths every morning down to the 
waist, followed by a brisk rub dow r n in a warm 
room are of immense value. Do not have the wa- 
ter any colder than the temperature at which the 
child will react and get in a warm glow after bath- 
ing. If there is no reaction and the child is cold 
and blue, the water has been too cold. The rub- 
bing afterwards with a rough Turkish towel is as 
important as the bath itself. 



64 CONSUMPTION 

Remove the child from all possible sources of in- 
fection. If there is or has been a case of consump- 
tion in the family or house, send the child away if 
possible. If there is definite disease of the lung 
itself, the child should be sent to a hospital or san- 
atorium, and should not be kept at home. There 
are not many institutions where such children can 
be sent. Massachusetts and New York are fairly 
well provided. Information about them can be ob- 
tained from the sources mentioned above. 

Many doctors advise exercises, calisthenics, etc., 
for this type of children. They are apt to be thin, 
" scrawny," round-shouldered and stooping. Un- 
der proper conditions a few simple " setting up " 
exercises are of benefit. But it is easy to carry 
this on too enthusiastically and to do harm instead 
of good. These should never be allowed except 
when ordered by a physician. It is well to remem- 
ber that round shoulders and flat chests often result 
from a general weakened condition. Under such 
circumstances it is rest outdoors, good food, and al- 
ways more rest which will build up the child, re- 
store vitality and energy and allow him to sit up 
straight of his own accord. Chest exercises, there- 
fore, should be allowed only when the child is well 
and strong enough to afford the spare energy neces- 
sary for their performance. It is far better to em- 
phasize rest in all such cases rather than exercise. 
Above all things, remember that questions concern- 
ing exercises and other matters should be decided 
by the physician and not by parents or relatives. 



CHAPTER XV 

FRESH AIR ROOMS AND OPEN AIR SCHOOLS. WHAT 
THEY ARE AND WHAT THEY ARE FOR 

The school children of to-day are the men and 
women of to-morrow. The weak, sickly, anaemic 
children of to-day are the consumptives of the next 
generation. The movement for fresh air rooms 
and open air schools is simply an expression of a 
growing public sentiment that children need and 
must have more fresh air and sunlight if we ex- 
pect to have them grow up into healthy adults. Sci- 
entists can prove to their own satisfaction, perhaps, 
that the air forced into school rooms by some elab- 
orate and expensive system of artificial ventilation 
is pure and fresh and just as good as the air that 
comes in through an open window; facts demon- 
strate that this is not so and that no amount of 
" baked " air equals that which comes into the room 
unimpeded and in its natural state. 

At the present time there are two great classes of 
children who need treatment in fresh air rooms or 
outdoor schools. The first and smaller class con- 
sists of those children whom competent medical 
authorities have declared to be not only tuberculous 
but to have tuberculous disease in active form. 

6s 



66 CONSUMPTION 

These children are sick children. They belong in a 
sanatorium or hospital where health is the prime 
consideration, and not in a school. For them 
schooling is a very secondary matter. The New 
York sanatorium at Stony Wold and the Massachu- 
setts sanatorium at Westfield are institutions of 
this type, sanatoria in every sense of the word, but 
provided with outdoor schools for children able to 
attend them. There are many smaller institutions 
of the same kind in or near the large cities in this 
country and abroad. 

The other class consists of those children under 
weight, often underfed, poorly nourished, pale 
and run down, who, while they doubtless are al- 
ready infected with tuberculosis, have no evidence 
of active tuberculous disease, and who need good 
food, proper hygiene, and fresh air to make them 
well and strong. The distinction between these 
two classes is often hard to make because one 
merges into the other. It is important to realize 
the difference, however. It is for these children 
that fresh air rooms are intended. Such a room 
may be simply one room in a schoolhouse set aside 
for this purpose, where the windows are either 
taken out or kept open, or it may be a shack, tent 
or pavilion actually out of doors. The children are 
adequately clothed to stand the cold weather. 
Lunches, simple, nourishing and cheap are provided 
at cost or free to those who cannot pay. A certain 
period each day is set aside as a rest hour. Home 
conditions are investigated. The interest of the 



FRESH AIR ROOMS 67 

parents is aroused so that both children and parents 
learn the value of fresh air and the rules for right 
living. 

The result in increased mental and bodily vigor 
of these children is amazing. Such schools have not 
been in existence long enough nor are there enough 
of them as yet to show any appreciable effect on the 
tuberculosis death rate or on the general health. 
In a few years this effect will be clearly seen. By 
that time the public will realize what those who have 
studied the subject now do, — that all children 
whether well and strong or weak and sickly, should 
go to school and study in fresh air rooms and that 
it is folly to wait until the child becomes run down, 
sick and infected with tuberculosis before he is 
given decent conditions at home and at school. 
This is to be the next great step in advance. 



CHAPTER XVI 

CONSUMPTION AND MARRIAGE. WHAT SHOULD 
CONSUMPTIVE PARENTS DO ABOUT THEIR CHIL- 
DREN? 

The question as to whether or not a consumptive 
should marry is one that frequently arises and is 
very hard to answer. No definite ruling one way or 
the other can be made. Each case must be decided 
on its individual merits, depending on the age of the 
patient, activity of the disease, finances, and other 
conditions. As a general thing such marriages 
should be discouraged unless matters have reached a 
stage where breaking off an engagement would do 
more harm than good. Certainly no young couple 
should marry, if one has consumption, unless every 
detail as to present and future plans are clearly and 
plainly talked over between the two parties. If 
the disease is active and there is no immediate pros- 
pect of its arrest, marriage should be postponed in- 
definitely. On the other hand, if the process is a 
chronic one and one that the physician believes to 
be compatible with a long and useful, although per- 
haps a semi-invalid life, there is no reason why 
there should not be a marriage, provided, as above 

stated, that both the man and the woman in the case 

68 



CONSUMPTION AND MARRIAGE 69 

are fully prepared to live according to what the dis- 
ease demands and are financially able to do so. 
Much depends on the intelligence of the contracting 
parties. I know of many patients whom I should 
not allow to marry under any circumstances if I 
could help it, even though in the incipient and fa- 
vorable stages; while on the other hand I know of 
many more with chronic advanced or moderately 
advanced tuberculosis, whom I would willingly al- 
low to marry. After all, in these cases it is fortu- 
nately or unfortunately true, according to the point 
of view, that only rarely will serious weight be given 
to any doctor's advice on this subject. 

Again the question is bound to arise as to whether 
there should be children from such marriages. If 
it is the husband who is consumptive, I can see no 
reason why there should not be children providing, 
of course, all possible safeguards are taken to pre- 
vent the child's becoming infected; if, however, it 
is the wife who is afflicted, this matter should be 
given the gravest consideration. Husband and 
wife should both remember that pregnancy with its 
attendant strain on all a woman's vital forces is the 
cause of more breakdowns and relapses among 
women than anything else; that many, many trage- 
dies have resulted from this cause ; that tuberculous 
disease that has been quiescent and free from all 
symptoms for months or years previous may again 
become active during pregnancy and the months fol- 
lowing child-birth. If it is decided to take this 
risk, the most watchful care on the part of the phy- 



70 CONSUMPTION 

sician and the closest cooperation between wife 
and physician is necessary to prevent disaster. Un- 
der certain conditions it is right and proper to termi- 
nate such pregnancy. This, however, is a medical 
question only and need not be entered into here. 

If one or both parents are or have been consump- 
tive, what is to be expected of the children result- 
ing from such a union? Remembering that tuber- 
culosis itself is not inherited, but that a lessened 
resistance or lowered vitality may be inherited, the 
parents need have no worry as to the outcome if 
they bear these facts in mind and act accordingly. 
Knowledge of what may be transmitted from a tu- 
berculous parent carries with it the power to ward 
off future trouble. Such children should not be 
nursed if the mother has active tuberculosis, but 
should be weaned at once. They should be brought 
up with the utmost care, not coddled or protected 
from fresh air, but living in it night and day. They 
should be protected from every source of contagion 
and should be examined regularly and frequently 
by a competent physician. If the child is reared 
under such conditions as these, his parents need 
have no fear, as far as tuberculosis is concerned, 
that he will not be as strong and well as any other 
child whose parents are apparently perfectly well 
and strong. 




How to wrap a patient in a chair. The reclining-chair is first overlaid with 
a rug or a comfortable, and double blankets extended their full length, 
leaving the free ends on the floor. Loaned by the Journal 
of the Outdoor Life. 




How to wrap a patient in a chair. After seating yourself, draw up the free 
ends of the blanket and tuck in at the sides. A steamer rug is placed 
over all. Loaned by the Journal of the Outdoor Life 



CHAPTER XVII 

THE PROBLEM OF PAYING THE BILLS IN CONSUMP- 
TION AND HOW THEY HAVE BEEN SOLVED 

Tuberculosis is a chronic disease; it takes time 
and money — plenty of both — to cure it 
Whether the patient and his friends are able to 
pay the bills, or whether they are paid by the state, 
city or private charity, some one has to pay the 
board and other expenses. Usually it is the tax- 
payer who foots the bills ; some day the public, who 
now pays the bills, will realize that it is far cheaper 
to prevent consumption than it is to try to cure it. 

The consumptive, unless he is very well off, should 
put away all pride. Only the wealthy have a right 
to pick and choose the exact sanatorium, climate 
and situation that they want. Most of us cannot 
do this, but must be content with what we can af- 
ford. Many patients are unwilling to go to a state 
sanatorium because they are not, as they say, 
" charity patients." This is all nonsense. In our 
state sanatoria patients are not officially pauperized 
by entering on a free basis. True, if a patient says 
he is unable to pay, his case is investigated by state 
or local authorities to make sure of the facts. This, 
however, does not pauperize him. Free treatment 

7i 



J2 CONSUMPTION 

at a state or local sanatorium is on the same plane 
as our public schools and our police and fire pro- 
tection. No one, even the poorest, would claim he 
was pauperized by not paying for education in the 
public schools. Tuberculosis is a great social and 
economic problem and one that society and the 
public must handle. For these reasons, then, when 
a person has consumption and must go to a sana- 
torium for an extended stay, he should face the 
financial side in a practical and sane manner. If 
he can afford $ioto$i8a w r eek at a private or semi- 
private sanatorium for a long while, well and good ; 
if he can pay only $4 to $5 a week, the usual cost 
for those who can pay at a state sanatorium, let him 
face the situation cheerfully. He should realize 
that comparatively few can go to private sanatoria 
and that he can get well just as quickly in the bigger 
and less expensive institution. If he is so situated 
that he cannot afford to pay for his board, let him 
say so frankly to the proper authorities. In Mas- 
sachusetts institutions, at least, the patient who can 
pay his four dollars a week or more receives exactly 
the same treatment in every detail as his less fortu- 
nate fellows who can pay nothing. There is no 
more important point to remember. In many 
cases, the vast majority, immediate treatment is 
highly desirable. Not only from the point of view 
of the patient's physical welfare is this a good 
thing, but also it is far easier for the patient to do 
something at once, to take some radical step while 



PROBLEM OF PAYING BILLS 73 

the doctor's advice and warning is fresh in his mem- 
ory, than to wait one or two months before so do- 
ing. Unfortunately in Massachusetts and I believe 
elsewhere, there is a long waiting list for all the 
state sanatoria, so that the patient must wait one, 
two, or even three months after he has filed his ap- 
plication before he can be actually admitted to the 
sanatorium. For many reasons, therefore, it is im- 
portant to bridge over this gap. Under such cir- 
cumstances I have advised many patients to go 
at once to a private sanatorium, even at a cost 
of $10 to $15 or more per week. While these 
patients could not possibly pay at such a rate 
as this for any length of time, many of them are 
able to do so for a few weeks. It is really the eco- 
nomical plan, because in most instances a few weeks 
of immediate treatment, even at increased cost, will 
be more than saved by the decreased length of stay 
in the sanatorium later on. The following brief 
reports of cases are those of actual patients, each 
of whom presented a definite financial problem 
which was satisfactorily solved. 

A. A woman with two small children, whose 
husband earns $2 a day, with no money saved, was 
found to have moderately advanced consumption. 
The children were sent to board with the grand- 
mother, after having been examined themselves. 
Application was made for admission to a state san- 
atorium and in the meantime the patient was admit- 
ted to a local hospital, the House of the Good Sa- 



74 CONSUMPTION 

maritan. Five weeks later her name was reached 
on the sanatorium list and she was admitted on a 
free basis. She is now doing well. 

B. A young clerk, single, with no one dependent 
on him, earning $15 a week, had incipient phthisis. 
He had $200 saved up. He was sent at once to a 
private sanatorium in the village of Rutland at $14 
a week, and application was made for the Rutland 
State Sanatorium. When his name was reached 
on the list he had done so well that he preferred to 
remain where he was, even at increased cost. At 
the end of two months he left the sanatorium, 
moved his quarters outside the city to a suburb 
where he now sleeps out of doors. At the end of 
six months he was able to go back to work, his em- 
ployers having kept his position open for him. 

C. A young boy of ten years, whose mother was 
a washerwoman, a widow, earning $10 a week, had 
been ailing for some time. The diagnosis of 
11 bronchial gland tuberculosis " was finally made 
and sanatorium treatment advised. Application 
was made for the Westfield State Sanatorium, Mas- 
sachusetts, where children are taken. In the mean- 
time, as there was no hospital or other institution to 
which he could be temporarily admitted, his home 
conditions were investigated in detail, his mother 
instructed as to how to take care of him, extra milk 
was supplied from a local diet kitchen, while the boy 
himself came weekly to my clinic at the Massachu- 
setts General Hospital. After two months' wait- 
ing, during which time he improved rapidly, he was 



PROBLEM OF PAYING BILLS 75 

admitted to the state sanatorium, where he is now. 
D. A young bank clerk, with a good position 
bringing in $20 a week, but no savings, came down 
with acute early tuberculosis. His wife was soon 
to have a baby. The couple had lived up to their 
income in an apartment in the suburbs. The prob- 
lem was a difficult one, involving not only the hus- 
band but the wife, who had no place to go. After 
considerable effort the officers of his bank agreed 
to continue the patient's salary for two months. 
The patient was admitted to the Prendergast Camp, 
an institution receiving at low rates patients near 
Boston, who later expect to enter a state sanatorium. 
The w T ife lived at home and when the time arrived 
for her to be confined, was sent to a local lying-in 
hospital free of charge. After she left this, her 
husband insisted on coming home and refused to 
consider going to a sanatorium of any kind. He 
was therefore persuaded to join a " tuberculosis 
class/' arrangements for outdoor sleeping were 
made, and he is now carrying on the home sana- 
torium treatment and doing well. In view of the 
young baby and the condition of the mother, it 
would have been far better if the patient had gone 
to a sanatorium until entirely cured; as this was 
impossible, the next best course was followed. 



CHAPTER XVIII 

DRUGS AND CURES FOR CONSUMPTION; THEIR USE 

AND ABUSE 

All nostrums, quack remedies, widely adver- 
tised " cures " for consumption, may be condemned 
at once. Leave them alone, no matter how glow- 
ing may be the reports you hear concerning them. 

The question as to the advisability of allowing in 
moderation, or occasionally, alcoholic drinks, such 
as beer, ale, porter, port wine, etc., is often raised. 
While in rare cases I allow or even advise patients 
to take a little beer or its equivalent with their din- 
ner, it happens so infrequently as to be negligible. 
It is far better to leave all such things alone. They 
are not " strengthening," as our friends are so apt 
to assure us when they present us with bottles of 
port wine, etc. The feeling of well being that re- 
sults is a very temporary one and does no good. 
Especially would I condemn the much overworked 
" egg-nog." This has its place in acute conditions, 
but not in tuberculosis. 

Creosote and similar nauseating drugs not only 
do no good, but much harm. I will not prescribe 
them for my patients nor take them myself. Cod 
liver oil and emulsions are widely advertised, if not 

76 



DRUGS AND CURES 77 

as cures, as potent agents in helping to bring about a 
cure for consumption. It should be borne in mind 
that such preparations are merely forms of fat and 
as such have some value. The taste is usually very 
disagreeable. Children often do not mind taking 
cod liver oil and occasionally relish it. If they are 
under weight, extra fat is a good thing. There 
are no special curative properties in oils and emul- 
sions. Personally I have never prescribed cod liver 
oil or an emulsion. If my patients need increased 
fat in their diet, I prefer them to take it in cream, 
butter, salads, and in other fatty foods. 

Tonics, hypophosphites, etc., should only be taken 
when prescribed by a physician. 

Serums and vaccines, etc., likewise should be al- 
lowed only under rigid competent medical super- 
vision. 

Inhalants of various kinds often help throat con- 
ditions and relieve annoying coughs. They never 
have cured tuberculosis, however. 

As a general rule, the^ fewer drugs or artificial 
foods or preparations of any kind are taken, the 
better for the patient. 



CHAPTER XIX 

DIET IN CONSUMPTION 

A good digestion is the sheet anchor in the treat- 
ment of consumption. It is what is digested and 
not what is eaten that counts. A tired and over- 
worked stomach cannot take care of food, no mat- 
ter how nourishing or attractively served. 

The days of " forced feeding " are past. We 
no longer try to put 20 to 30 pounds on the patient, 
urge him to eat all he can and as often as he can, 
and congratulate ourselves when at the end of six 
months he is fat, plethoric and short-winded. This 
has done much harm in the past. Each patient pre- 
sents an individual problem as to diet and feeding. 
As a general rule I like to have my patients put on 
about ten pounds over the weight which they con- 
sider normal. In fat patients it is often wise to 
reduce weight ; thin ones should be given more food. 

Remember that there is nothing of any specific 
value as far as tuberculosis is concerned in milk or 
eggs. Milk is a good nourishing food and so are 
eggs, but no one with a chronic disease will benefit 
by living on this diet to the exclusion of other arti- 
cles of food. Eggs and milk should be taken sep- 
arately, never as " egg and milk," " milk shake," or 

78 




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DIET IN CONSUMPTION 79 

" egg-nogs." I usually advise my patients to take 
three square meals a day and in addition one quart 
of milk. A quart of milk makes about six glasses. 
These are to be scattered through the day with and 
between meals. Substitute a raw tgg for a glass of 
milk if you wish to, or better still, take a raw tgg 
after your meals if extra food is desirable. Some 
people take raw eggs without any " fixings." Most 
persons break the tgg in a cup and add a little lemon 
juice or salt, pepper and vinegar. Countless pa- 
tients have told their doctors that they cannot pos- 
sibly tolerate either milk or raw eggs. Persons un- 
doubtedly do exist whose stomachs will not take 
to either eggs or milk, but they are exceeding rare. 
Usually it is merely a fad or a fancy on the part of 
the patient and the sooner it is got rid of the better. 
The question of appetite, or rather the lack of ap- 
petite, is often a perplexing one. As a general 
thing, it is safe to regard an appetite as a luxury 
belonging to well people. A lack of appetite in 
consumption is simply a symptom of the disease; 
this the patient should remember and also that he 
must eat even if he does so without much enjoy- 
ment. This brings up a most important point in 
feeding not only consumptives but all such people, 
namely that a little food attractively and daintily 
served will do far more good than much larger 
amounts piled on the plate. The patient's friends, 
nurse or attendant can spend time and energy to no 
better effect than by studying this subject, prepar- 
ing dainty meals and in seeing to it that each time 



80 CONSUMPTION 

the patient is given his tray or sits down to the ta- 
ble for a meal, the food before him is small in 
amount and attractively served. Too small help- 
ings are far better than too large ones. It is infin- 
itely better for the patient to say, " Is this all I'm 
going to get? I know I'll want some more! " than 
" Oh, dear, I can't possibly eat all this!" These 
may seem like small points ; they are really very im- 
portant ones, however. In regard to the diet itself, 
as long as it is simple and nourishing, there is little 
to be said. If the patient is under weight, plenty 
of fat in the form of butter, etc., is desirable. Sal- 
ads of all kinds with French or mayonnaise dressing 
are excellent. Fresh fruit is sometimes apt to 
cause upsets and should be taken only in modera- 
tion. Regularity at meals is essential. 

Rest is needed for the stomach just as much as 
for any other part of the body. The stomach is 
simply a bag of muscle which, like the other muscles, 
is apt to be flabby and weak when there is active 
tuberculosis present in the body. For this reason 
it is advisable for the patient to take one-half hour's 
rest before and after each meal; before meals so 
that the stomach is in good condition before any 
food is put into it and after meals so that all the 
patient's strength and energy may be devoted to 
the subject in hand — that of digesting and assim- 
ilating food. 

The number of times a patient should eat depends 
on circumstances and in its final analysis should be 
decided by the physician. As a general rule, there 



DIET IN CONSUMPTION 81 

should be three regular meals a day, with light 
lunches at n a.m. and 4 p.m. Such lunches 
should be daintily served and may consist of a glass 
of milk, broth, cocoa, a sandwich, crackers and 
cheese, etc. If it is found that these lunches pre- 
vent the patient from eating his regular meals, they 
should be reduced or given up altogether. Be 
guided by common sense and not by cast iron rules 
in this as in other matters. 

There is no part of the treatment of the consump- 
tive in which the patient's family, nurse or attendant 
can do more good and can really help more to bring 
about a cure than by faithful, painstaking attention 
to the details of feeding the patient. 



CHAPTER XX 

HOW TO KEEP FROM GIVING CONSUMPTION TO 

OTHERS 

Tuberculosis is a contagious disease. It is not 
so highly infectious as scarlet fever, measles, small- 
pox, etc., but nevertheless, it is classified with them 
as a disease " communicable and dangerous to pub- 
lic health." As before stated, it is spread from one 
person to another by the germ of tuberculosis in the 
sputum or other discharges. How to live so as not 
to endanger those about him is the great and fun- 
damental lesson every consumptive must learn. The 
sputum is the chief means of the spread of tuber- 
culosis from one person to another. Were all the 
sputum destroyed, it is safe to say that there would 
be very little more consumption. Destruction of all 
sputum, then, is essential. This may be done in va- 
rious ways, depending on the amount which is raised 
in the twenty-four hours. If this amount is slight, 
paper napkins serve the purpose admirably. The 
patient is provided with an ample supply of paper 
napkins and a large paper bag. Each time a nap- 
kin is used to collect the sputum it is placed in the 
bag. At night the bag and its contents is burned. 

If the patient prefers, small squares of cheesecloth 

82 



GIVING CONSUMPTION TO OTHERS 83 

may be used in place of the paper napkins. This 
of course is slightly more expensive. When the 
amount of sputum is greater, this arrangement will 
not do. In such cases, paper sputum cups should be 
used and the entire cup burned when filled. These 
cups vary in size and price. They are so well known 
and so easily obtained as to need no description. 

The patient and his family must always bear in 
mind that sputum in even the smallest amount 
is dangerous. Therefore, whenever the patient 
coughs or sneezes, a handkerchief or napkin must 
be held in front of the mouth. The patient should 
kiss no one. Scrupulous cleanliness of face, mouth, 
teeth and hands is necessary. Eating utensils 
should be boiled after using. It is not necessary to 
mark the dishes conspicuously, but it is certainly 
safer for the patient to have his own knife, fork 
and spoon, plate, etc. As to clothing, everything 
which can stand it should be boiled. Bed clothes, 
blankets, spreads, etc., should be hung outdoors in 
the sun, if possible. All unnecessary floor and wall 
coverings should be removed from the patient's 
room, and the furniture should be of the simplest. 

Before allowing others to use a room previously 
occupied by a consumptive, the room should be 
thoroughly cleaned. Formalin and other chemical 
disinfectants are not so good as mechanical clean- 
liness. Information as to how to have this form 
of disinfection done, however, can be obtained from 
the local or state board of health. The floor and 
the walls up to at least four feet and more, if possi- 



84 CONSUMPTION 

ble, should be scrubbed. To be absolutely safe the 
floor might be painted and the walls painted or re- 
papered. The patient's room, the sleeping porch 
and piazza should be screened and every effort 
made to get rid of flies, as they have been repeatedly 
shown to be carriers of the germs of tuberculosis. 

Constant watchfulness is the price of safety. 
Well and strong adults need not seriously worry 
about getting the disease, but children and young 
adults, particularly if they are in any way physically 
below par, are extremely susceptible. It is far 
better to send all such persons away from the imme- 
diate environment of a consumptive, be he ever so 
careful. If conditions are such that this is impos- 
sible, the greatest of care must be used. 



CHAPTER XXI 

GENERAL REMARKS 

Fear of consumptives and consumption, — 
" phthisiphobia " as it is called, in its proper sense, 
means a wholesome respect and dread of the disease 
and a keen realization of its dangers. Carried to 
excess this feeling has done much harm and caused 
much unnecessary suffering. Fortunately it is grow- 
ing constantly less. The person who lives and sleeps 
outdoors is no longer a marked individual, because 
outdoor sleeping and living has become so popular. 
In addition to this, the public is beginning to real- 
ize that every one is more or less exposed to the dis- 
ease and that the average strong and healthy adult, 
living a sensible, hygienic life, need not fear the 
careful consumptive. It has been clearly demon- 
strated that the standard of health of doctors, 
nurses, and attendants in tuberculosis sanatoria or 
resorts is higher than elsewhere and that their death 
rate from consumption is lower. For these reasons 
remember that while the consumptive is a sick per- 
son, he is not necessarily to be shunned and ostra- 
cised as is so often done. 

Remember also, that the consumptive is sick ; that 
he is not himself, owing to the poisonous toxins in 

85 



86 CONSUMPTION 

his system. He is apt to be fretful, irritable and 
easily upset by little things. While it is often the 
kindest course to be firm with the patient, the ut- 
most gentleness, patience and tact are necessary at 
all times. In my own experience I have not found 
that the " spes phthisica," — " the consumptive's hope 
and optimism/' — is so often present as gloom and 
despondency, with an ever present tendency to look 
on the dark side of things. This must be constantly 
combated. 

Remember that the consumptive, just as much as 
a well person, needs a change of scenery and sur- 
roundings once in a while. There should be occa- 
sional shifts in the nursing force; a different room 
may well be used, or the arrangement of the room 
altered. Best of all is a more radical change to a 
different locality or climate. In the Massachusetts 
sanatoria there is a constant shifting of patients 
who have stayed many months at one institution 
and who seem to have reached a stationary condi- 
tion, getting neither better nor worse, to another 
sanatorium in a different part of the state. This 
often brings about a remarkable improvement. It 
is, of course, no reflection in any way on the institu- 
tion the patient has left. 

In the early stages of treatment, when absolute 
or nearly absolute rest is indicated, a strict medical 
atmosphere is an advantage. The patient must be 
made to realize that he is sick, just as one with ty- 
phoid fever or pneumonia is sick. This is neces- 
sary in the beginning. But later on, when he has 




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GENERAL REMARKS 87 

learned how to live and to recognize symptoms and 
their significance, it is well to eliminate the medical 
side as much as possible. It is perfectly possible, 
I believe, to keep a patient too long at Saranac Lake. 
It is hard to forget the disease while there. Pa- 
tients will discuss their symptoms and compare 
progress with other patients, much to the disad- 
vantage of each. When this stage is reached (and 
the physician is the one to decide this), make some 
radical change. There is a condition known to tu- 
berculosis workers as " post-sanatorium neurasthe- 
nia." The patient has become so introspective 
while at the sanatorium that he constantly watches 
every symptom and is unwilling to do anything fo 
help himself in any way, although perfectly able to 
do so. This is an unfortunate and quite unneces- 
sary state of affairs. 

Consumption is curable. This was the slogan of 
our warfare against the disease ten years ago. At 
the present time, while consumption in its early 
stages we all know to be curable, we are more con- 
servative in speaking of its curability in later stages 
of the disease. Consumption is preventable always 
and curable often. What constitutes a cure in con- 
sumption? This is a hard question to answer defi- 
nitely. In my own work, I am unwilling to call a 
patient cured until he has been at least three years 
without symptoms, without signs of any active dis- 
ease in the lungs or elsewhere and able to lead a nor- 
mal life. The term " arrested " is the safer one to 
..oe. This simply means that while there may be 



88 CONSUMPTION 

signs of extensive and fairly active disease in the 
chest, often accompanied by cough and sputum, the 
patient himself is well and strong, eats and sleeps 
well, is up to his normal weight and is able to do 
work of some kind. Such a person certainly is not 
cured; he is liable to a relapse at any time, but on 
the other hand, such a condition as this is quite com- 
patible with a long and useful life. 

Consumption as a social and economic problem 
has at last awakened the interest of the great la- 
bor organizations and of the employers of labor. 
Slowly but surely the idea has crept into their minds 
that it is better and cheaper to keep well by living 
and working under decent conditions than it is to 
get sick and then to have to pay out much money in 
order to get well again. This accounts for the 
great spread of the " welfare work " in factories, 
stores, and other large concerns and is a great step 
in advance. 

Rest versus exercise in the treatment of con- 
sumption is a point hotly fought. Each has its 
place. It is probably true, however, that too much 
exercise has caused countless deaths and that it is 
difficult to give a patient too much rest. If a pa- 
tient is told to exercise, he is very apt to go too far 
and to exercise until fatigue sets in; it is then too 
late and the harm has already been done. One 
must stop exercising long before actual fatigue sets 
in. One of the best known authorities in this coun- 
try, who has had consumption himself, has said that 
if he had to take treatment all over again, he would 



GENERAL REMARKS 89 

go to bed and stay there for six months or more, 
until all symptoms disappeared. These are wise 
words. 

Outdoor sleeping is advisable in the great major- 
ity of cases. There are some people, however, who 
cannot do this, especially during the cold season. 
They cannot be made comfortable, they do not sleep 
well and there is as a result a useless waste of vital 
energy. In these cases the wise physician will com- 
promise and allow the patient to sleep indoors in a 
room well provided with windows that are of course, 
kept wide open. 

A cough is considered a necessary accompaniment 
to pulmonary tuberculosis. A certain amount of 
coughing is almost always present, it is true, but 
there is a great deal of energy wasted in useless 
coughing. The avoidance of dusty streets, crowded 
halls, theatres, etc., on the part of the patient will 
help ; a simple oil spray inhaled well down in throat 
and trachea will often prevent much coughing, while 
most important of all is the mental training of the 
patient not to cough except when absolutely neces- 
sary. If this is done, much strength will be saved 
that otherwise would have been wasted. 



CHAPTER XXII 

HINTS AND HELPS FOR TUBERCULOSIS 

PATIENTS 

By Charles L. Minor, M.D. 

Dr. Minor's " Hints and Helps " appeared origi- 
nally in the Journal of the Outdoor Life. It is here 
reprinted by the kind permission of the editor of the 
Journal of the Outdoor Life. It was written pri- 
marily for Dr. Minor's own patients ; hence the local 
references. 

EXERCISE 

i. None at all for one week after arrival, then 
ask the doctor about it. 

2. Never exercise to the point of fatigue; stop 
before you are tired and don't walk " on your 
nerves." 

3. None if your afternoon temperature the day 
before was over 99.5 or if your morning tempera- 
ture that day is 99 °. 

4. None if you are uncomfortably short of breath, 
or if your pulse generally runs over a hundred. 

5. None for one hour after meals. 

6. None if your sputum is bloody or even pink. 

90 



HINTS AND HELPS 91 

7. No hill climbing unless it is specifically ordered. 

8. No pulmonary or other gymnastics or deep 
breathing save when ordered. 

9. No driving or horseback without permission — 
walks come first. 

10. If you get caught in the rain while out, and 
get wet, it will not hurt you if you keep on walking, 
and as soon as you get home, take an alcohol rub and 
put on dry clothes. 

11. In increasing your exercise never do it sud- 
denly, but by small additions each day. The Greek 
athlete, Milon, of Crotona, when asked how he be- 
came strong enough to carry a full-grown bull up 
a mountain-side, said that he accomplished it by car- 
rying it every day from the day it was born, his 
body thus being gradually accustomed to a strain 
which at first would have been too great for it. 

REST 

1. Remember that rest comes before exercise and 
that the latter is only useful after the former has 
so built up the system that there is a surplus of 
energy to draw upon above and beyond the ordinary 
demands of your body. Until the doctor finds that 
you have reached that point, exercise is harmful, 
and persistent, unfretting rest is best for you. 

2. If the temperature is over 99.5 °, rest recum- 
bent in a proper reclining chair. 

3. If the temperature is over 100.5 , either be re- 
cumbent on a cot outdoors or in bed. 



92 CONSUMPTION 

4. If your temperature is 101 or over, go to bed 
at once and let the doctor know, 

OUTDOOR LIFE 

1. Aim to spend a minimum of 8 to 10 hours out- 
doors daily, i.e., 9-1 ; 2-6 ; 7-9. If you can do more, 
so much the better. If you are in earnest about get- 
ting well you will not dawdle and waste precious 
time indoors that might be spent in the fresh air, by 
getting late to breakfast or loafing indoors after- 
wards, nor will you seize every excuse to stay in the 
house. If, after returning to your home from the 
sanatorium or health resort, you are of necessity in- 
doors, in an office or otherwise, all day, it is im- 
portant to make up for the fresh air thus lost by 
sleeping out at night. When on the contrary you 
are living out all day long, sleeping out at night is 
not essential, if your room has two or more win- 
dows. 

2. If at first you cannot keep warm outdoors in 
the winter, use more wraps or a hot water bag or 
get up and take a short walk, or come in and warm 
for a short while. Never stay outdoors while you 
are chilly, but learn never to be chilly outdoors. It 
is difficult if not impossible to keep w T arm outdoors 
in winter if your feet are on the ground, hence you 
should have a proper reclining chair. With such a 
chair and proper wraps you can soon learn to keep 
warm in all weathers. 

3. Chairs that have concave canvas backs and hol- 
low the shoulders, and stoop them, should be 



HINTS AND HELPS 93 1 

avoided ; a proper chair must have a broad, Hat back, 
and should alter its position easily from erect to re- 
cumbent. Always keep your shoulders erect whether 
sitting or standing; stooped, narrow shoulders limit 
your breathing space and do your lungs harm. 

4. Be out of doors, but protected from the wind 
and the weather, in all weathers, the only exception 
being during sleet storms ; if in doubt telephone the 
doctor. 

5. Keep your head out of the sun; it will tend to 
run up your temperature. If the weather is hot in 
summer it is often best to be quiet indoors for a part 
of the afternoon rather than uncomfortably warm 
outdoors. 

FOOD AND EATING 

1. The ideal food should be appetizing, very nu- 
tritious and not too bulky. 

If appetizing but not nutritious it will undernour- 
ish you ; 

If nutritious but not appetizing it will disgust 
you; 

If too bulky, however appetizing, it will stuff you. 

2. If your digestion is good, a generous mixed 
diet (favoring especially red meats, eggs, milk, and 
fats) is sufficient. A raw egg and a glass of milk 
at 1 1 and at 4, if it does not spoil the appetite for the 
next meal or unduly " stuff " you, is desirable ; but if 
it upsets or overloads you stop it and ask the doctor. 
If you find you often wake in the night and cannot 
go to sleep again, you probably are undernourished 



94 CONSUMPTION 

and should take something to eat. If you wake 
more than an hour before breakfast in the morning, 
don't go hungry to breakfast, but eat something. 

3. If your digestion is poor the doctor will give 
you special orders. 

4. If your stomach feels heavy or painful after 
meals, if there is belching, or if the morning urine 
becomes muddy on standing, you are probably over- 
eating or your digestion needs attention. Ask the 
doctor. 

5. As to the right amount to eat, never burn too 
little coal under a boiler or you won't make steam, 
nor too much, else it will all go out of the chimney 
in smoke and clog the boiler tubes. Learn to burn 
every bit that you can properly consume — no more 
and no less. 

6. Be on time at meals and talk while you eat. 
If it is good natured talk it will aid digestion. 

7. Never eat at irregular or odd times, and eat no 
candy, save directly after meals. 

8. Never eat when you are tired, and never take 
exercise on a full stomach; it is a sure way to pre- 
vent good digestion. Therefore if tired, rest a half 
hour before meals and always be quiet one hour 
after. This gives your stomach time to prepare for 
and to do its work. After the mid-day meal spend 
one hour recumbent and silent out of doors. 

9. Extra milk and eggs at 1 1 and 4 are valuable. 
They are always to be taken unless stopped by doc- 
tor's orders; but if they seem to overtax your stom- 
ach, let the doctor know at once. Usually from two 




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HINTS AND HELPS 95 

to six raw eggs and from four to six glasses of milk 
can be taken in twenty-four hours with benefit. 

10. Eat slowly and chew well if you wish to get 
the full value from your food, and always drink 
your milk slowly. 

11. If you have any medicines to take at meal- 
time, remember other people's susceptibilities and 
take them in private where you will not be seen. 

12. Discourage sluggish bowels. They poison 
you. 

CLOTHING 

1. In winter wear a medium weight of wool next 
to your skin, unless you are accustomed to a linen 
mesh. In summer, in this climate (Asheville), a 
very thin wool-cotton mixture, or linen mesh, is 
best. 

2. Never wear very heavy underclothing or chest 
protectors. At night never sleep in a night gown or 
pajamas only, unless they are of outing flannel, but 
put on a light undershirt next your skin. 

3. Let your shoes be stout and warm in winter. 

4. In winter wrap warmly out of doors and have 
an extra wrap always handy in case of a change in 
the weather. 

5. If you get overheated and perspire change your 
clothes and rub dry. 

6. Never change the weight of your clothes with- 
out due consideration, remembering that 

" Beneath this stone, a lump of clay, 
Lies Uncle Peter Dannels, 



96 CONSUMPTION 

Who early in the month of May, 
Took off his winter flannels." 

During the first warm days of early spring it is 
wise to remember the old saw, " Stick to your flan- 
nels till your flannels stick to you." 

In this climate you can generally wear your winter 
underclothes till the middle of May or even the first 
of June, and your summer ones till the 15th of No- 
vember or the 1st of December. 

It is often desirable to have an intermediate weight 
of underclothing for spring and fall. 

BATHING AND CARE OF THE SKIN 

1. A healthy activity of the skin is important, 
hence there should be a warm bath twice a week at 
bedtime. 

2. The skin should be hardened against catching 
cold, hence a cold salt sponge taken at the bedside 
immediately on rising is wise, if ordered and as or- 
dered. 

3. Should you be chilly or blue after your cold 
bath, or if you are sick, or have a cold, or if your 
sputum is pink, or if your w r aking temperature is 
under 97 °, stop the bath and tell the doctor. 

4. When taking a cold bath your room should not 
be under 50 ; 6o° is better. 

5. If you suffer from chilliness try salt and alco- 
hol rubs. If you tend to perspire too freely, vinegar 
and alcohol rubs. 



HINTS AND HELPS 97 

THE ROOM 

1. In winter it should preferably, but not neces- 
sarily, face south, southeast or southwest ; in summer 
usually a north, northeast or northwest room is 
cooler and more comfortable. 

2. Have two, or preferably more, windows and an 
open fireplace, if possible. One-windowed rooms 
cannot be properly ventilated unless they have a fire- 
place, but can be made available by using a window 
tent. 

3. If a furnace flue opens into your room, keep 
it shut tight. 

4. No room mates should be allowed save by spe- 
cial permission, and no bedfellow under any circum- 
stances. Two single beds are hygienic; two people 
in a double bed is unhygienic. 

5. When in your room and not in bed, the room 
had best be between 65 ° and 68°. When well cov- 
ered up in bed no degree of cold will hurt you. 

BED AND SLEEP 

i. Be in bed by 10 p. m. in summer and 9 in win- 
ter, and do not read in bed. Sleep not less than 8 
hours no more than 10. 

2. Open all windows the last thing before getting 
into bed and have them closed one hour before rising. 

3. As soon as accustomed to it, keep all windows 
open save when hoarse or during a cold, in which 
case ask advice. Find out if you sleep with your 



98 CONSUMPTION 

mouth open. If so, ask the doctor. It is harmful. 

4. Arrange your bed with your head near a win- 
dow but do not sleep in a cross draught or with your 
head in a corner. 

5. Use enough covers to keep warm, but avoid 
heavy bedding. Another mattress will often be bet- 
ter than another blanket, and if you cannot keep 
warm in bed, double mattresses with newspapers be- 
tween them, or a hot bottle, or woolen leggings, or a 
thin flannel sheet, or an outing flannel wrapper will 
help you. As has been said earlier, always wear a 
light undershirt next to the skin in bed. 

AMUSEMENTS 

1. Never forget that while amusement is neces- 
sary for everyone, he who has not the grit to deny 
himself pleasure for profit, to give up an amusement 
however much desired, for the benefit of his health, 
has not the force or the ability to succeed in any- 
thing. 

2. Avoid amusements which subject you to dust, 
or to getting overheated, whether indoors or out; 
for example : dancing, bowling or tennis. 

3. Avoid exciting games, such as bridge-whist, 
or poker, or those which, like chess, or an expert 
game of whist, demand too much mental concen- 
tration. 

4. If a musician, you must not play music which 
excites or deeply moves you. Light music for a 
short time will not hurt you. 

5. An active correspondence with relatives and 



HINTS AND HELPS 99 

friends is not allowed. You may write one letter a 
day if your fever is not 100.5 °, but if you wish to 
write more, ask the doctor. Tell your correspond- 
ents not to keep you posted on all the worrying 
things which happen at home. If they can't write 
cheerfully, don't let them write at all. 

6. Avoid amusements which keep you for a long 
time indoors, or which tend to make you lose your 
temper. 

7. No theater or night entertainments save by 
special permission. 

8. No shopping if avoidable, and no loafing 
around town. When you walk, walk in the coun- 
try. Report all trips to town. 

9. If your temperature is over ioo°, no visitors 
can be seen. (Excuse yourself by putting the 
blame on the doctor ; he is used to being blamed and 
can stand it better than you.) 

10. No visiting without the doctor's permission. 

CARE OF THE VOICE 

1. If you are hoarse or if you have any throat 
trouble, limit your speaking to the absolute mini- 
mum — complete silence is best. Each spoken 
word is a physical injury to a weak organ. 

2. Always avoid hot, dry or dusty rooms, but es- 
pecially when hoarse. 

3. Never strain your voice by loud or continuous 
talking or by calling to people at long distances. 

4. Smoking is not allowed without special per- 
mission, and inhaling under no circumstances. 



ioo CONSUMPTION 

5. Do not sing without telling the doctor. If 
your throat is not perfectly healthy it will injure it. 

COUGH AND EXPECTORATION 

1. The only cough which is useful is that which 
easily brings up sputum; any other is harmful to 
you and irritates your respiratory tract. Therefore, 
unless it comes up easily, never try to bring up some- 
thing by hard coughing. By practice and will 
power seventy-five per cent, of your cough can be 
suppressed; therefore suppress it, 

2. When you cough, always cover your mouth 
with a handkerchief and not your bare hand as you 
can thus soil it. If you want to know why you 
should cover your mouth, hold a bright, clean look- 
ing-glass in front of it while you cough once or 
twice and note that it will be speckled all over with 
tiny spots which came out of your mouth and lungs. 

3. If talking increases your cough, lessen your 
talking. 

4. Always suppress your cough at table; if you 
cannot, leave the table. 

5. If coughing is troublesome and keeps you 
awake, a dose of cough medicine at bed is usually 
wise; ask the doctor. In the daytime, until you 
have learned to control your cough, a dose or so 
may help a weak will for awhile, but never become 
dependent on it or let it take the place of your will. 

6. Never spit on the ground, even out of doors, 
or anywhere else, save in a sputum box or pocket 
spittoon, or, where these cannot be used, in a square 



HINTS AND HELPS 101 

of cheese cloth, to be used but once and to be placed 
after such use in a special rubber lined pocket till it 
can be burned. 

7. Never swallow your expectoration under any 
circumstances; this can be very dangerous for you. 

8. Avoid soiling your hands by rubbing them on 
your lips; wash your hands often, and be careful 
to clean your teeth two or three times a day. 

9. Kissing may be an agreeable pastime, but until 
you are thoroughly well and have no more cough or 
expectoration, it should be given up. In any case, 
kissing on the mouth is not wise or healthy, and 
should be permanently given up, especially when 
kissing little children, to whom it is very dangerous. 

10. Should, by accident, the floor or anything else 
become soiled by expectoration, it must be carefully 
wiped up at once, with a one to twenty solution of 
carbolic acid in water, and some of this solution 
should be allowed to soak into the spot for an hour 
or so afterwards. 

11. If the above precautions are fully observed, 
there is no need for anxiety as to any danger of in- 
fection for yourself or others. Tuberculosis is not 
easily transmissible like smallpox or scarlet fever, 
and among decently cleanly people, in clean houses, 
it is with difficulty handed on to others. 

MEDICINES 

1. None unless ordered. 

2. Stop any that will upset your stomach or spoil 
your appetite, and tell the doctor at once. 



102 CONSUMPTION 

3. No alcohol without special permission. 

4. When taking medicines don't let other people 
see you. Put yourself in their place. 

MISCELLANEOUS 

1. Remember that everything which is not ex- 
pressly allowed is forbidden. 

2. If in doubt about anything, telephone the doc- 
tor. It won't bother him and it may save you from 
hurting yourself. Patients are not allowed to 
weigh in the drug stores or anywhere else save the 
doctor's office. 

3. If you catch cold or feel badly in any way, 
telephone the doctor at once. 

4. In the beginning, if you are not used to fresh 
air, don't go all at once to fully open windows and 
constant outdoor life in cold w r eather, but in a few 
days you will be able without difficulty to live the 
life strictly and with pleasure. 

5. Avoid following the advice of solicitous 
friends without first consulting the doctor. 

6. One of the most dangerous times for you is 
when you reach the point where, while not yet really 
well, you feel perfectly well. Then it is that even 
the most prudent are apt to forget what they have 
been taught and to overdo. Remember that in this 
trouble the symptoms can all cease long before the 
disease is really cured, and that, excellent as it is to 
feel entirely well, only a careful physical examina- 
tion and a long observation can prove you so. 




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HINTS AND HELPS 103 

7. When inclined to complain of the weather re- 
member the old jingle, and don't. 

" As a rule man's a fool, 
When it's hot he wants it cool ; 
When it's cool he wants it hot — 
Always wants what he's not got." 

8. The relation of the patient and the doctor in 
this trouble is of extreme importance, and if the 
results of the treatment are to be satisfactory, a 
complete co-operation and confidence between them 
is essential. 

The nature of this relationship is shown by the 
following: A man once owned a steam yacht on 
Lake Ontario, and was his own captain, sailing the 
boat wherever he pleased without anyone's aid. 
One day, however, he was obliged to go down the 
St. Lawrence River to Montreal, and much against 
his will, started on the trip. When he reached the 
Thousand Islands he put up for the night, and as 
he did so, a man on the dock asked him where he 
was going. " To Montreal." " But you have no 
pilot ! " " Oh, bless you, I don't need any pilot ; 
I always run my boat myself and need no help." 
" Well," said his interlocutor, " that does very well 
on the Lakes where you have deep water, but in this 
river there are rapids and hidden rocks and whirl- 
pools, and you, who know nothing about them, are 
pretty sure to wreck your boat." The owner there- 
upon hunted up a pilot, who, after carefully inspect- 



104 CONSUMPTION 

ing the hull and engines, said, " Now, please go 
down and stoke the fires carefully with good coal so 
as to keep up a good steam pressure, and run the 
engines according to my ideas and not yours, for if 
you don't, I can't possibly get you through; but 
don't come into the pilothouse and bother me, for I 
will have all I can do to get your boat safely through 
to Montreal. When we are passed all the dangers, 
I will turn her over to your own control, and you 
should then be able to run it yourself under all ordi- 
nary conditions." 

MENTAL ATTITUDE 

I. Never talk of your case or symptoms with any- 
one save the doctor, and allow no one to talk of 
theirs to you. Remember the saying, " I have trou- 
bles of my own; go tell yours to the policeman," or 
in the words of the popular hymn, " Go bury thy 
sorrows, Let others be blessed, Go give them the 
sunshine," etc. 

" What can be more unkind than to communi- 
cate our low spirits to others, to go about the world 
. . . poisoning the fountains of joy? Have I more 
light because I have involved others in the same 
gloom as myself? Is it not pleasant to see the sun 
shining on the mountains, even if we have none of it 
down in the valley? Oh, the littleness and the 
meanness of that appetite for sympathy that will 
not let us keep our sorrows to ourselves! Let us 
hide our pains and sorrows. But while we hide 



HINTS AND HELPS 105 

them, let them also be spurs within us to urge us on 
to all manner of overflowing kindness and sunny 
humor to those around us." — Faber. 

2. Don't Fret or Worry. Fretting or worrying 
never helped anyone. If you cannot change condi- 
tions, an uncomplaining acceptance of them will not 
make them more hard to bear and often will reveal a 
silver lining to the darkest cloud. We take the 
sunshine as our right; why not accept the clouds 
cheerfully? "Heroism for most of us consists in 
cheerful endurance. . . . Our training for the 
needs of new adventure comes from this familiar 
experience of courageous bearing in the hours of 
trial. Not to whimper, not to cringe, never to lis- 
ten to the voice of despair, never to make our burden 
an addition to the loads of other burdened men, to 
follow the gleam in the darkness, to hold to God in 
grief, to obey with no reason given, when the law is 
made plain — he who can walk thus through the 
shadowed way is arming himself for high adventure 
and great service. 

u Every trouble is an opportunity to win the grace 
of strength. Whatever else trouble is in the world 
for, it is here for this good purpose, to develop 
strength. It is something which is hard to do, and 
. . . strength is increased by encounter with the dif- 
ficult. A world without any trouble in it would be 
a place of enervation and laziness. . . . Every day 
w r e are blessed with new opportunities for the de- 
velopment of strength of soul." — Hodges. 



io6 CONSUMPTION 

3. If thinking makes you blue, use your will 
power, stop thinking of that which worries you and 
think of something else: its good practice for your 
will. 

" Cultivate your will power. Bring the will to 
bear upon your daily thinking. Has it ever oc- 
curred to us that we can will our happiness ? The 
proverb runs that, ' Everyone is happy who thinks 
he is/ and the supreme point here is, that we cm 
order our thinking. You cannot . . . regulate the 
external weather by volition. The rain comes 
down without asking your leave, but our mental 
weather is in our own hands. We can disperse the 
clouds here by an effort of the soul. The grandest 
liberty we possess — and we all possess it — is that 
of choosing our outlook. Let us in these matters 
be masters in our own house. Why not hope in- 
stead of fear and trust instead of despair? We 
have not learned the art of living unless we have 
learned the art of willing. The disciplined soul 
thinks of possible evils just so much as is needful 
for practical action and no more. It will not dwell 
under cloud when it knows the way to clear sky." 

4. Don't be impatient to get well ; it will only re- 
tard your recovery. Nothing worth having in this 
world ever comes quickly or easily, and a good cure 
is often a slow one. Remember that to no half- 
hearted or light-minded seeker after health will heal- 
ing come ; that the results are largely dependent upon 
the will power, intelligence, determination and per- 
sistence of the patient; that while the doctor can 



HINTS AND HELPS 107 

show you the way, only YOU can walk in it. Keep 
up your side of the partnership with the doctor hon- 
estly ; remember that you must work hard as well as 
he; be in earnest, cultivate your will power; be 
hopeful; be cheerful; see the bright side, for good 
spirits is the best medicine, and sunshine of a smile 
can dissipate many a cloud. 

" Talk happiness ! 
Not now and then, but every blessed day, 
Even if you don't believe 
The half of what you say; 
There's no room here for him 
Who whines as on his way he goes ; 
Remember, son, the world is 
Sad enough without your woes. 

" Talk happiness each chance 

You get — and talk it good and strong ; 

Look for it in the byways 

As you grimly plod along; 

Perhaps it is a stranger now 

Whose visit never comes — 

But talk it ! Soon you'll find 

That you and Happiness — are chums." 

J. W. Wright. 



THE END 



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JOHN B. HAWES, 2D, M. D. 

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